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Kirklees Primary Care Trust

RELATIONSHIP AND SEXUAL HEALTH EDUCATION (R&SHE) POLICY & PRACTICE GUIDANCE, FOR HEALTH CARE PRACTITIONERS WORKING IN THE KIRKLEES YOUTH JUSTICE SYSTEM Responsible Directorate:

Patient Care & Professions

Date Approved:

12th March 2008

Committee:

PEC

Signature of Accountable Director: Print Name:

Page 1 of 32

Sheila Dilks


Version Control Document Title

Relationship & Sexual Health education (R&SHE) Policy & Practice Guidance for Health care Practitioners Working in the Youth Justice System.

Document number

1

Author

Gill Addy

Contributors

Janine Lees, Karina Hepworth, Lindsay Andrews & Erika Farey

Version

1

Date of Production

Feb 2008

Review date

Feb 2010

Postholder responsible for revision

Health Advisors Kirklees Youth Offending team

Primary Circulation List Web address Restrictions

Standard for Better Health Map. Domain

Core / Development Standard Reference Performance Indicators

First – Safety Fourth – patient Focused Fifth – Accessible & responsible Seventh – Public Health C2, D1, C13, C16, D9, C18, C19, D11a&c, C22 a& c, C24 1. Reduction in unwanted pregnancies & sexually acquired infections among young people in the Kirklees youth justice system. 2.Supervision strategy within safeguarding services including R&SHE

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CONTENTS 1.

Introduction

4

2.

Associated Policies & Procedures

4

3.

Aims & Objectives

8

4.

Scope of policy/practice guidance

8

5.

Accountability & Responsibility

8

6.

Context

9

7.

Principles & values of delivering effective R&SHA

9

8.

Confidentiality

9

9.

Working with sexually active young people under age 18

10

10.

Working with parents/carers & families

11

11.

Practice guidance

11

11.1

Talking about R&SHE with young people

11

11.2

Puberty/menstruation & masturbation

12

11.3

Religion, culture & RSHE

13

11.4

Sexuality

14

11.5

Substance misuse

14

11.6

Pornography

14

11.7

Sexual exploitation

15

11.8

Safer sex – condom distribution

15

11.9

Emergency hormonal contraception (EHC)

15

11.10 Pregnancy testing & access to services

15

11.11 Chlamydia testing

17

11.12 Teenage pregnancy support

17

12.

Equality Impact Assessment Tool

17

13.

Training needs

17

14.

Monitoring & Compliance

18

15.

Reference & bibliography

18

16.

Appendices

19

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Policy Statement Kirklees PCT is committed to providing health support to young people who are involved with the Youth Offending Team (YOT). It is the duty of the Health Advisor in post to address the holistic health needs of young people, including the promotion of good sexual health. The Health Advisor will be expected to be involved with a variety of initiatives such as reducing teenage pregnancy, sexually acquired infections & the promotion of relationship & sexual health education. Health Advisors are expected to work collaboratively with other agencies to promote healthy messages & to adhere to the agreed policies & procedures as laid out by the PCT & supported by the Kirklees YOT.

1. Introduction We are informed from research that all young people want to talk about sex and relationships with someone they can trust. As health care practitioners we are in the privileged position to proactively offer support and guidance on relationships and sexual health issues, and become a trusted adult for children and young people involved directly or indirectly with the Youth Justice System. The health team also recognise the diverse nature of the needs of the young people, and ensures the delivery of tailor made interventions to suit individual’s strengths, needs & abilities. The health team recognise the importance of user involvement in practice & seek to ensure young people contribute to the development of the service. This has included the shaping of for example; the health needs assessment, condom distribution service & delivery of R&HSE. This document is intended to support health care practitioners to promote the sexual health and wellbeing of children and young people who are involved directly or indirectly with the Youth Justice System. This document has been developed in direct response to national guidance from DH and the DfES including the Teenage Pregnancy Unit guidance ‘Enabling Young People to Access Contraception and Sexual Health Information and Advice’ [2004]. 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 document does not advocate or promote sexual experimentation nor condone any breaches of the law. The health care practitioner is expected to adhere to guidelines & protocols set out by the Nursing & Medical Council (NMC), Kirklees Primary Care Trust (KPCT), Local Children’s Safeguarding Boards (LCSB), & with agreement from the Kirklees Youth Offending Team Management Board. This 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, and Working together to safeguard children. (Relevant document summary see appendix 1).

2. Associated Policies and Procedures The Law, regulations and guidance United Nations convention on the rights of the child [ratified 1991]. Page 4 of 32


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 2004 The Strategic Health Authority, local Primary Care Trust & Youth Offending Team (YOT) among other agencies are partners of the Children’s Services Authority in England, as outlined in the Children Act (2004). The agencies have a duty to safeguard & promote the welfare of young people in their authority. This includes provision of education & promotion of positive physical, mental & emotional well being, with a view to improving the lives of young people. Young People involved with offending have a range of needs that distinguish them from the non-offending population. They are more likely to have been in care, witnessed or been the victims of domestic violence & crime. Young people involved in offending often have difficulty accessing mainstream health services due to lack of parental support & are more likely to truant or be excluded from school. The impact of this is they miss vital education about healthy lifestyles. Delivering relationship & sexual health education (R&SHE) in the youth offending service can bridge this gap for a group of vulnerable young people in a safe arena. .

. 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 child’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 procedures. Page 5 of 32


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 must still adhere to the Kirklees safeguarding board child protection procedures and seek advice from their line manager as necessary, ensuring accurate records are kept of contacts/discussions etc. In all cases concerning a child under 13 years old, consultation with the safeguarding team should take place & agreed actions documented. 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 health 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). Page 6 of 32


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 to 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. Page 7 of 32


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, need to establish whatever information is known about 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.

3. Aim and Objectives To provide a clear framework enabling health care practitioners to effectively support young people directly or indirectly involved with the Youth Justice System, on issues related to relationships and sexual health.

To clarify the role and responsibilities of health care practitioners with regard to providing R&SHE, advice and support to young people associated with the Youth Justice System.

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

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 young people.

4. Scope of the Policy/Practice Guidance This document should be followed by the health care practitioners working in the Kirklees Youth Offending Team

5. Accountability & Responsibility It is the duty of the health care practitioner employed by the Primary Care Trust (PCT), working in the Youth Offending Team & responsible for delivery of R&SHE in the YOT to ensure the information within this document is current, relevant & accurate. This document has been developed by Kirklees Primary Health Care Trust professionals working in very close partnership with Kirklees Safeguarding Specialist provision professionals and Kirklees Youth Offending Team Management Board. Accountability for information provided in the policy lies jointly with the:Kirklees Safeguarding & Specialist Provision Services, Kirklees Youth Offending Team Management Board & the Director of Children & Young People’s Services. And:Page 8 of 32


Kirklees Primary Care Trust, Assistant Director for Safeguarding Children & Vulnerable Adults, working to the Director of Patient Care and Professions.

6. Context The Youth Justice Board (YJB) oversees the youth justice system in England & Wales. It works to prevent offending & re-offending by children & young people under the age of 18. One of the responsibilities of the Board is to oversee the work of the Youth Offending Teams (YOT). These multi-agency teams are made up of staff from the police, probation, social services, education, housing & health. The staff are able to work with & respond to a wide range of young peoples` needs. As part of the creation of the YJB through the Crime & Disorder Act (1998), it became an obligation for all YOT`s to include health practitioners in their teams. The YJB considers each young person in contact with the youth justice system whether in custody or in the community, eligible to access a comprehensive health service as much as any other young person in the general population (YJB B281 2007). The health practitioners working within the YOT have the opportunity to access, care, support, provide interventions, facilitate access to services & provide health promotion to young people on a wide variety of subjects.

7. Principles and Values of Delivering Effective Relationship and Sexual Health Education (R&SHE) R&SHE is lifelong learning about sex, sexuality, emotions, relationships and sexual health. Through R&SHE children and young people acquire accurate information, develop skills and develop positive values, which will guide their decision-making, judgements, relationships and behaviour throughout their life. R&SHE 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 R&SHE should; •

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

8. Confidentiality Confidentiality is an issue that can cause great anxiety for young people & health practitioners 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. ƒ

All service users have the right to expect that all their personal information is kept in

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confidence. However in cases where a child protection issue is disclosed, health practitioners must follow the safeguarding procedures and report their child protection concern to their child protection lead professional. ƒ

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

ƒ

Health care practitioners 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 young people & parents whenever possible and appropriate.

ƒ

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). A sharing of information agreement is signed by the health care practitioner & the young person involved with the Youth Offending Team prior to any health intervention commencing.

ƒ

9. 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: ƒ

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

ƒ

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.

ƒ

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

ƒ

Misuse of alcohol/substances as a disinhibitor.

ƒ

Attempts to secure secrecy by the sexual partner.

ƒ

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

ƒ

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

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ƒ

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.

10. Working with Parents/Carers and Families The Children Act [1989] emphasises the importance of working in partnership with parents. Whilst the act states that parents have shared interest & responsibility, decisions that are made should be in the best interest of the child. •

YOT health literature will inform parents of the RSHE Policy& practice guidance and explain the health practitioner’s role in delivering information & advice on R&SHE.

If parents/carers wish they could be given the opportunity to discuss the information provided about the policy & practice and any concerns they have regarding this should be documented.

All discussions with parents/carers relating to R&SHE should be accurately recorded.

If parents/carers do not agree to their child receiving R&SHE, a discussion should take place based on the wishes of the young person, Frazer competency, & other avenues for the young person to access the information if this is deemed appropriate. A compromise should be sought in the best interest of the young person.

Where a decision has been reached to overrule the parents’ wishes relating to R&SHE and advice for their child, a clear rational for the decision must be provided to the parents/carers and clearly recorded. A discussion between the health practitioner & his/her line manager would be advisable, to offer advice & support.

11. Practice Guidance 11.1 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 health care practitioners acknowledge that the lack of confidence, embarrassment and low self esteem of some young people make it especially difficult for them to ask for help, to negotiate in relationships and to confidently access contraception and sexual health services. Health care practitioners should therefore proactively provide support and information on such issues. When talking about relationships and sexual health issues health care practitioners should; Page 11 of 32


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.

The health practitioner should not share personal sexual information during individual or group work sessions. Good practice when starting a session is to agree ground rules, especially in a group work setting when confidentiality cannot be guaranteed by other attendees.

Provide appropriate resources to use with young people, taking into consideration age, previous sexual history (if known) for example; issues of sexual assault, domestic violence, learning disabilities, low self-esteem, or they may or their partner have been through a conception.

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 respond sensitively to a young person who may tell you that they are gay, lesbian, bisexual, or that they are confused about their sexuality.

Understand that young people may have very different attitudes and values to sexual behaviour from your own. It is the practitioner’s 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 involved with the youth justice system and that this can affect their values and beliefs.

Peer pressure is a major influence in the lives of all children and young people, the health practitioner role is to offer opportunities to openly discuss relationships and sexual health, empowering young people to resist peer pressure.

11.2 Puberty, Menstruation & Masturbation 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. Health care practitioners should be prepared to; •

Sensitively advise on increased hygiene needs, if recognised as a supportive action for that individual. Group work may also be done as a general session within a programme of identified topics aimed at increasing health awareness.

Encourage healthy eating and an active lifestyle.

Be aware of the signs and symptoms of eating disorders and seek consultation/supervision from the Child and Adolescent mental health service [CAMHS] or support a referral to the young persons GP if any concerns arise.

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In cases where a young person has developed acne, depending on the effect on the child, a discussion to support the young person accessing the GP may be welcomed.

Girls Health care practitioners should be prepared to; •

Offer advice and/or signpost to make an appointment with the young girl’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.

Offer advice and/or signpost a girl to their GP if she is experiencing painful or irregular periods.

Boys The health care practitioner should be prepared to; •

Offer to support the young boy to access his 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.

Young people who have committed a sexual offence should be offered R&SHE along side a risk assessment & supported if necessary by the SHIELD Project. (a local service offering advice, assessment, therapeutic intervention & training to agencies working with young people who display sexually harmful behaviour. Masturbation Masturbation is part of normal sexual behaviour, for both males and females. Health care practitioners 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.

11.3 Religion, Culture and Relationships and Sexual Health Education Religious and cultural differences may affect how R&SHE 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: “Practitioners 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).” Health care practitioners should; •

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Ensure that any R&SHE 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 Looked after Children’s health team to enquire about details regarding this book & possible loan.

11.4 Sexuality R&SHE should be supportive of and responsive to the needs of all 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, health practitioners need to approach these issues sensitively. Health care practitioners should; •

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

Deliver all R&SHE within an inclusive framework, and not presume all young people are heterosexual. Using terms such as ‘partner’ could be seen as good practice.

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 appendices ]

Appropriately challenge issues of homophobia, prejudice and discrimination.

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.

11.5 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 a priority for health care practitioners. When the use/misuse of substances is suspected and may increase risk taking sexual behaviour. Health 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 within the Youth Offending Team.

11.6 Pornography It is important to realise that an increasing awareness, and interest in pornography is a normal Page 14 of 32


part of puberty and developing sexual feelings, but material that gives a stereotyped, distorted or exploitative view of males & females may be particularly damaging to young people who may have a history of being sexually abused. (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.)

11.7 Sexual Exploitation Health care practitioners should be aware of the potential for vulnerable young people to be sexually exploited leading them into prostitution. Young people in the youth justice system like other young people in the general community may have been subject to past or suffering current abuse. There is a particular vulnerability associated with young people attending the Youth Offending Team who may also be children looked after by the local authority, and this can make them particularly vulnerable to exploitation, sexual or otherwise. If there are concerns that a young person is involved in or at risk of sexual exploitation, Kirklees’ Local Safeguarding Board Child Protection Procedure policies must be followed.

11.8 Safer Sex - Condom Distribution Condoms are provided by workers who have completed a Kirklees Safeguarding and Specialist Provision approved training course on condom distribution. Research demonstrates that a significant proportion of condom failure is due to incorrect use. The guidelines for the supply of condoms should be followed. • • • • • •

Follow local service arrangements for the distribution of free condoms. Obtain condom supplies from health authority designated supplier are to European Commission standard. Ensure verbal and written advice about the correct usage of the condom is supplied. Ensure information about sexually acquired infections and sexual health services are available. Ensure information on where and how to access emergency contraception. The service may form part of a programme of R&SHE delivered by the health practitioner either in 1:1 or group work format.

11.9 Emergency Hormonal Contraception (EHC) Health care practitioners should ensure that young people (including under age 16) are aware that they can access confidential, free emergency contraception to avoid an unwanted pregnancy 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 in the grounds of Dewsbury and District Hospital and is open weekdays [including bank holidays and Christmas day], 8.30am -6.30pm • pharmacies are now able to provide EHC to buy to people over 16 years old. Individual Chemists choose whether they wish to offer this service. Please refer to appendix 16b for opening times of clinics & GUM.

11.10 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. Page 15 of 32


Only health care practitioners who have completed a Kirklees Safeguarding and Specialist Provision approved training programme should undertake pregnancy testing, and have the authorisation of their line manager that this procedure is part of their role. A consent/confidentiality agreement should be completed by the worker & young person before the test is completed, to ensure agreement on the process following the test & to be clear regarding Frazer competency, child protection and safeguarding procedures if necessary. A positive pregnancy test must result in advice being given for the young person to attend a Contraception & Sexual Health Service (CASH), [see appendix] or GP. (The health care practitioner should inform the allocated social worker if the young person is looked after by the local authority). The health care practitioner 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 anyone to know, then the health care practitioner should support them. Child protection procedures should be followed if any concerns arise & supervision from child protection personnel as appropriate. 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 soon after. The type of pregnancy test should be the one currently used by the local 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 health care practitioner should support them to access the relevant service for onward referral to antenatal care or to the unplanned pregnancy clinic (UPAC) to discuss options & allow informed choice. UPAC details in appendix 16b Individuals who have positive or negative pregnancy test results should have continuity of care offered, whether this is through the health care practitioner or CASH service to address their on-going contraceptive needs. Any unprotected intercourse may have resulted in a sexually acquired infection and appropriate screening is recommended. Termination of pregnancy If terminating the pregnancy is the option chosen by the young woman, & if the health care practitioner is involved in supporting the young person, he/she should consult with his/her line manager for consultation/supervision. When agreement is made on the plan to support the young person the health care practitioner may help or advise access to termination services, via the GP or Contraception & Sexual Health (CASH) Services [see appendix]. It would be best practice to ensure the young person understands the information supplied by the clinic for before & after the procedure has taken place. Contact should be maintained if the young person requests the practitioner’s involvement. The health care practitioner must discuss with the young person the benefits of informing parents/ carers, documenting the outcome of the discussion. If the young person does not wish to inform them, 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 health care practitioner should support the young person to access CASH services [see appendices] to address their on-going Contraception needs.

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Thinking about adoption If the young person is considering adoption, the health care practitioner should discuss with the young person that contact with Social services will be necessary, as well as discussion with parents/carers if appropriate. Support will be offered to do this.

11.11 Chlamydia Testing National & local data demonstrates that young people are having sex without contraception leading to sexually acquired infections (Calderdale & Huddersfield NHS Trust 2004). It has been agreed between Wakefield District, Calderdale & Huddersfield NHS Trust & Kirklees PCT that a specialist Chlamydia screening service will be provided to young people under 25 years old. The service will run separately to the mainstream GUM services already provided. The service is for use in alternative venues including youth offending teams, once ratified by the clinical governance procedures. Asymptomatic young people will be offered a urine test, provided they have not been screened in the past year or who have had a negative test in the past but have now a sexual relationship with a new partner. Young people who have taken antibiotics in the last 6 weeks will be asked to wait at least another 6 weeks after completion of the course of their medication before being screened. The screening is voluntary, it is carried out by the health practitioner at the YOT initially, comprising of a discussion & collection of a urine sample in a confidential manner. The health care practitioner is then responsible for arranging for the sample to be collected or taken to an agreed distribution point for transportation for analysis. Any further contact regarding the sample is between the young person & the appointed Chlamydia screening staff, including any treatment & follow-up. Health care practitioners are there to offer further advice & support if approached by the young person.

11.12 Teenage Pregnancy Support The recent development of a Teenage Pregnancy Support Worker & two Teenage Pregnancy Midwives, has provided a dedicated support structure to young people in the district. This recent development of roles is an extension of the current support offered to young people involved with the Kirklees YOT by midwives employed by Calderdale & Huddersfield NHS Trust. The partnership working has allowed for vulnerable young people to access vital services before & after birth & allow relationships between health professionals & clients to develop which may otherwise have been difficult to establish.

12. Equality Impact Assessment All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess & consult on how policies & functions impact on race equality.� This obligation has been increased to include equality & human rights with regard to disability, age & gender. The PCT aims to design & implement services, policies & measures that meet the diverse needs of our service, population & workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines & practices. This policy/practice guidance was found to be compliant with this philosophy.

13. Training Needs The effective implementation of this policy and practice guidance is dependant upon access by the health practitioner to regular updates, meetings & training as deemed necessary to enable competent practice.

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Condom distribution is a service that is provided within the Kirklees YOT. It is undertaken by staff who have attended & completed the Kirklees Safeguarding and Specialist Provision approved training course on condom distribution. The service is overseen by the health practitioner attached to the YOT. Pregnancy testing in Kirklees YOT is only undertaken by health care practitioners who have attended a Kirklees Safeguarding and Specialist Provision approved training course on pregnancy testing. A Chlamydia screening service co-ordinated by the local NHS Trusts is supported in the Kirklees YOT & overseen by the YOT health practitioners. Line Managers in health should provide the health practitioner with supervision as required, & involve the YOT manager contact for health, in discussions relating to practice as necessary. In the event of public controversy or adverse publicity, providing that staff have acted within the policy guidelines management will support the health practitioner. Clear, accurate & comprehensive record keeping is required, in accordance with the Guidelines for Records & Record Keeping (NMC 1998) It is expected that the health care practitioner employed to deliver R&SHE attend relevant training as supported by the PCT & other agencies in order to ensure skills are maintained. Attendance and involvement with the Teenage Pregnancy Strategy groups are required to allow for networking & collaborative working.

14. Monitoring & Compliance It is the responsibility of the health care practitioner employed by the PCT & working in the YOT to refer to the key performance indicators outlined in this policy & to monitor its content on a six-monthly basis or sooner if necessary. The key aspects to be observed will be to support the Teenage Pregnancy Strategy, to reduce unwanted pregnancies & sexually acquired infections (SAI`s) by; providing free pregnancy testing, condoms, Chlamydia screening, education & sign posting to relevant services. The safeguarding of young people in the context of R&SHE will be observed and action taken if necessary, following guidelines set out by the Kirklees Safeguarding Children’s Board. The methodology used to ensure the policy remains relevant & compliant to current arrangements will involve communication in person, verbally & through literature from agencies involved in R&SHE & ratified by the PCT as acceptable resources for information. The process of reviewing results will entail record keeping of interventions regarding testing, screening & attendance of young people involved in sexual health issues. The health practitioners in the YOT are part of & feed into the local & national picture of statistics for reducing unwanted pregnancy & SAI`s through the Teenage Pregnancy Strategy & the Chlamydia Screening Service.

15. 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 fact sheet 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 /Care leavers. A resource for teenage pregnancy co-ordinators. Barnardo’s 2003. Page 18 of 32


NMC (1998) Guideline for Records & Record Keeping Youth Justice Board (2007) Health (B281) Kirklees Metropolitan Council/Primary Care Trust (2007) Relationships & Sexual Health Education Policy – for social care practitioners & foster carers with LAC in Kirklees. DfES (2004) Every Child matters: Change for Children in the Criminal Justice System. HMIP (2006) Lets talk about it – A review of Healthcare in the Community for Young People who offend. Healthcare Commission. Children Act (2004) HMSO DoH (2004) Standards for Better Health Calderdale & Huddersfield NHS Trust (2004) Health Practitioner Protocol for Urine Chlamydia Testing with sexual Health Advice to Young People.

16. Appendices 16a 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’.

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.

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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 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). Page 20 of 32


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 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

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

16b. Contraception & Sexual Health (CASH) Services. SOUTH KIRKLEES Princess Royal Clinics Tel: (01484) 344260 Monday 1.00pm – 3.00pm 3.30pm – 4.45pm 4U (Under 25) Tuesday

9.30am – 11.30am 5.30pm – 7.30pm

Wednesday

9.30am – 11.30am 3.30 – 4.45pm 4U (Under 25)

Thursday

12.30pm – 3.00pm 5.30pm – 7.30pm

Friday

9.30am – 11.30am 3.30pm – 4.45pm 4U (Under 25)

Saturday

10.30am – 12.00pm (under 25)

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

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

GU Medicine Clinic (Princess Royal) Tel: (01484) 344311 Ring anytime for an appointment. NORTH KIRKLEES Batley Health Centre Tel: (01924) 351550 (by appt) Monday 9.30am – 11.30am 6.00pm – 8.00pm Tuesday 9.30am – 11.30am (alternate weeks) 2.00pm – 4.30pm (Young person’s clinic) Wednesday 5.30pm – 7.30pm Friday 1.30pm – 3.30pm

Batley Unplanned pregnancy advisory clinic (UPAC) Tel: (01924) 351551 (by appt.) Tuesday 8.45am – 11.30am (alternate weeks) Wednesday 8.45am – 2.30pm

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Cleckheaton Health Centre Tel: 01924)351550 Monday 5.30pm – 7.30pm (alt. weeks) Tuesday 9.30am – 11.30am (alt. weeks) Thursday 2pm – 4pm Young person’s drop-in clinic Thursday 5.30pm – 7.30pm Cleckheaton UPAC Tel. 01924 351551 Tuesday 8.45 – 11.30am (alternate weeks)

Dewsbury Health Clinic Tel: (01924) 351550 (for appointments) Tuesday 5.30pm – 7.30pm Thursday 9.30pm – pm 5.30 pm – 7.30pm 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 3.00pm – 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 Page 23 of 32


College student’s condoms and pregnancy testing available. (College academic year)

Chestnut Centre, Chestnut Street, Deighton Tel: (01484) 234234 Friday 3.30pm – 4.45pm Drop–In for young people Cleckheaton Health Centre Tel: (01924) 351550 (for appts. or advice) Thursday 2.00pm – 4.15pm 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. Huddersfield Technical College Choices Centre EO10 Tel.07845 731682 Monday 8.30 am– 9.30am 11.15am – 12.15pm Wednesday 8.30am – 9.30am 11.15am – 12.15pm Friday 8.30am – 9.30am 11.15am – 12.15pm Brunel House (first aid room) Tel. 07845 731682 Monday 12.30pm – 1.30pm Wednesday 12.30 pm – 1.30pm

16c. Types of Contraception Contraceptive Method

Advantages

Disadvantages

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. 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-the-clock 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

™ 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 premenstrual 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

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progestogen-only pill can stop ovulation, which means it prevents the ovaries from releasing an egg. Implants One small progestogenprimed tube inserted under the skin of the upper arm. The protects against pregnancy for up to 3 years.

™ Does not interrupt sex ™ Works for up to 3 years ™ Fertility returns immediately after implant is removed.

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

™ Does not interrupt sex ™ Women to not have to remember to take the pill ™ May protect against cancer of the womb

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

™ Does not interrupt sex ™ Works for 5 years ™ Periods may be lighter or may stop completely, until the IUS is removed.

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

™ Does not interrupt sex ™ Can be worn while swimming, having a bath or exercising ™ Women do not have to remember to take the pill

Diaphragms and Caps Diaphragms are domeshaped 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.

™ May protect against some STIs and cancer of the cervix. ™ Only needs to be used when having sex ™ Can be put in before sex

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™ Does not protect against STIs ™ Periods may be irregular or stop altogether ™ Can cause headaches and skin problems. ™ Does not protect against STIs ™ Periods may be irregular or stop altogether ™ Can cause headaches and skin problems ™ 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 protect against STIs ™ Can cause irregular bleeding at first ™ Can cause temporary side-affects such as skin problems or breast tenderness. ™ 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 sideaffects such as blood clots and breast cancer. ™ 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


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.

™ Does not interrupt sex ™ Works immediately ™ Works for between 3 – 10 years depending on the type of IUD fitted ™

Natural Family Planning This is a difficult method of 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.

™ No side affects ™ Can be used to plan pregnancy or avoid pregnancy ™

™ 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) ™ 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.

16d. Sexually Acquired Infections Infection & Treatment

Symptoms may include

If Untreated

Gonorrhoea

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

Can lead to pelvic inflammatory disease and infertility.

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.

Can lead to pelvic inflammatory disease and infertility.

Inflammation of the fallopian tubes. Abdominal pain, weakness, painful periods, pain during sex, bleeding between periods. Sometimes symptom less.

Increased risk of eptopic pregnancy and infertility due to damaged fallopian tubes.

Blisters and sores around the genital and anal areas when urinating, flu-like illness, headache.

Virus remains in the body and can result in further attacks. Highly infectious during an attack. Risk passing to others

Bacterial Infection Antibiotics

Chlamydia Bacterial Infection Antibiotics

Pelvic Inflammatory Disease (PID) Caused by a range of bacterial infections, commonly Chlamydia and Gonorrhoea. Antibiotics Genital Herpes (Herpes Virus ii) Page 26 of 32

Simplex


Viral infection Antiviral treatment and measures to reduce/prevent further attacks. Genital Warts (Human Papilloma Virus)

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 the cervical cells. changes in If untreated risk passing to others may disappear, could stay the same or grow larger in size & number.

Viral infection

Lotions, creams or warts frozen or cut off. Hepatitis B

Flu-like symptoms, tiredness, joint pains, weight loss, jaundice.

Can result in permanent liver damage or cancer.

Viral infection Treatment will depend on severity of inflammation of liver.

Most adults recover fully. 2-10% will remain chronic carriers.

If the individual is at continuing risk of Hepatitis B following their primary course of vaccine, after 5 years a single (booster) dose is required. Hepatitis C Viral infection Treatment will depend on severity of liver damage. Less often sexually transmitted than Hepatitis B.

Human Immunodeficiency

Symptoms are uncommon. If present they are similar to those of Hepatitis B.

If untreated or continued risky taking behaviour can lead to cirrhosis of the liver & liver cancer.

80% will remain infected and infectious.

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

Virus (HIV) Retrovirus If infected will remain infectious. No cure but management of virus with combination therapies Thrush (Candida Albicans)

In women: thick, white discharge, itching, and pain when urinating.

Yeast Infection Pessaries and cream Page 27 of 32

In men: rash and/or soreness

Pass on to others


for women

under the foreskin.

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

Yellow, green or white smelly discharge from vagina or penis. Pain when urinating, pain during sex.

Increased risk of contracting & transmitting HIV virus. Inflammation of fallopian tubes or Prostate Gland.

Often symptomless.

Pubic Lice Parasites Lotions (as for head)

Syphilis

Bacterial Infection Antibiotics

Severe itching around the genitals.

Symptoms continue. Pass on to others.

Small nits (eggs) on pubic hairs. Black powder (lice droppings) in underwear. 1st stage: painless sores, in women effects vulva, clitoris, cervix, urethral opening, anus & mouth. In men: Urethral opening, penis, foreskin, anus & mouth.

3rd stage if untreated: symptoms subside with no obvious sign, but can last for life. After many years if left untreated can cause damage to heart, brain eyes, organs, bones & nervous system. Could be fatal

2nd stage: painless rash patchy or all over. Flat, warty growths on vulva in woman & anus in men & woman. Flu like illness. White patches on tongue. Patchy hair loss

16e. Useful Organisations & Websites YOUNG PEOPLE SITES 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.

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 Page 28 of 32


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 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 Children’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 Page 29 of 32


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. 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. Barnado’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 Page 30 of 32


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 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 31 of 32


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.

Acknowledgement is given to Lindsay Andrews, Health Advisor for Looked After Children and Erika Farey, Public Health Associate Specialist, for a recent policy “R&SHE for Social Care Practitioners & Foster carers working with Looked after Children in Kirklees� (2007), and on which this policy & practice document is based.

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