Discussing sex with young offenders and children in care has helped tackle high teenage pregnancy rates in Reading, reports Louise Hunt
● Name: Youth outreach nurse specialist (Yons).
● Aims and objectives: To provide a flexible, sexual health and contraceptive service for young people considered to be at greater risk of teenage pregnancy and poor sexual health, including those who have recently had an abortion and those known to children’s social care.
● Number of service users: In 2009-10, 240 referrals with 95% follow-up.
● Cost of project: £50,000 per year.
● Timescale: The Yons service has been running for two years.
Two years ago Berkshire West Primary Care Trust was bewildered by the fact teenage pregnancy rates in Reading had risen, despite rates falling in all other areas of the trust.
An analysis by a joint board of the PCT and Reading Council found there was a need for a specialist service for vulnerable young people.
The solution was to create a youth outreach nurse specialist who would take referrals not only from NHS services but also from children’s social care, youth offending, substance misuse teams and pupil referral units.
“It was important to develop a range of referral networks to reach the young people. It is important to intervene early to avoid the pattern of repeat pregnancies among some vulnerable young people,” says Jane Wells, Berkshire West assistant director of public health.
One objective of the outreach service was to increase uptake of long acting reversible contraception (Larcs) above other forms of contraceptives, which it has achieved by nearly 60%.
Karen Suvarna, the nurse specialist who took up the youth outreach post, says: “I am working towards getting the young people on a reliable form of contraception. Larcs are one of the methods that are discussed if they suit the person’s lifestyle and it is likely that condoms might fail or the pill won’t be taken regularly.”
She emphasises that promoting Larcs is not about taking away choice: “My approach is the same as it would be in a clinic with any other patient group, there is no element of coercion. “Getting the young person to engage can be a challenge. They can be standoffish at first, but then often open up to seek advice about other aspects of their lives.
“They have multiple issues and I see helping them as all part of the service. I don’t see my role as going in there and forcing them to use contraception.”
Integral to the post’s success is being able to see young people in venues in which they feel comfortable – any setting is considered, as long as it is fit for purpose and can offer a confidential area. Suvarna is employed by the contraceptive and sexual health service at Royal Berkshire Hospital, but consultations and clinical delivery take place in a variety of settings across Reading, including Connexions, social services, schools and colleges and GP practices, or through home visits.
“We found that vulnerable young people didn’t like going into hospital, so we tried to provide a non-stigmatising service,” says Anna Wright, Reading director of education and children’s services and co-chair of the Reading teenage pregnancy strategic partnership board. “Karen goes where the young people are – this might be youth clubs, coffee shops, or their homes. It is where they feel comfortable. She develops a relationship with them, so they are not just in a queue to see a nurse. They trust her advice.”
She adds that this approach is making a difference to take-up of the service among young people who are in care: “Previously, the young people would have been pointed in the direction of drop-in services, but if a social worker didn’t physically take them there, often they would not go.”
Wright says the number of referrals from children’s services are lower than those from the other referral pathways “because the number of sexually active children in our care is fairly small”. However, she says social workers are told to consider if there is any evidence that a young person could be engaged in risky sexual behaviour and to refer them to Suvarna with their consent.
“There is no point in forcing them to receive advice, and it is really important they have an understanding as to why they are being referred,” she says.
A good time to raise this topic with a child in care is while talking through the young person’s life plan. “The social worker might say ‘we think you might be at risk of an early pregnancy or a sexually transmitted infection’. We are the child’s corporate parent so we have to have those conversations,” says Wright.
Suvarna says, in her experience, there is scope for social workers to give more consideration to the sexual health of young people. “Social workers are aware of my role, but they have got so many issues going on with those young people that sometimes I don’t think sexual health is talked about. Young people in care are not accessing mainstream sexual health services as much [as other young people] so it would be helpful if social workers could think more about how to talk about sexual health and flag up the risks with them and encourage them to see me.”
Wright agrees there needs to be a greater role for social workers in delivering sexual health education. She points to recent research by the Reading joint teenage pregnancy strategy group, which set up focus groups in wards with lower and higher risk of unwanted pregnancy to try to define the difference in attitude of the young people. The research found that those in lower risk groups tended to be more resolute, with more positive attitudes towards their future and how to protect themselves from risk. Conversely, the high-risk groups tended be more ambivalent, lacking in self-esteem and did not think of their future beyond six months.
“Our research shows the difference to being a vulnerable young person at risk of unwanted pregnancy is not so much about sex education but how they feel about themselves. The learning was that we need to focus on the ambivalent young people and how we can help them to develop a future story for their lives. We are encouraging social workers to help young people to have aspirations and engage in education or apprenticeships. The number of looked-after children with personal development plans was 70% and now is almost 100.”
Overall, the Yons service is achieving its goal of reducing unwanted teenage pregnancy in Reading, confirms Wells. “Teenage pregnancy rates in Reading have now fallen by 30%, which is higher than the national average drop in teenage pregnancy of 18%.
“We do feel the outreach approach, in combination with the wider teenage pregnancy strategy, is having an impact.”
(Picture: Jame Wells, by Chris Sharp)
Tips on sex education outreach
● Make it relevant to a child’s age and situation.
● Address wider issues of risk-taking behaviour and what leads children into taking risks.
● Discuss what are healthy relationships.
● Examine self-esteem issues.
● Talk about strategies for keeping control and being able to say no to situations.
● Use discussions on contraception and sexually transmitted infections as a starting point.
● Make sure information and services are provided in places of children’s choice.
● Respect their choice and beliefs.
● Move at their pace.
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