On-site sexual health services in education settings

1. Sex Education Forum www.ncb.org.uk/sef On-site sexual health services in education settings

2. Sex Education Forum www.ncb.org.uk/sef Topics for today… Prevalence of on-site sexual health services in education settings Characteristics of on-site service provision Effectiveness and quality of on-site sexual health services Linking on-site sexual health services with chlamydia screening Maximising learning about chlamydia in education settings.

3. Sex Education Forum www.ncb.org.uk/sef Secondary schools and PRUs 29% of secondary schools have on-site sexual health services (in a sample covering 70% of local authorities) This represents 627 schools – including single sex and mixed schools, faith and non-faith schools, special and independent schools Even more common in pupil referral units (34%) 16% of services in schools are specialised – providing a wide range of contraception Wide variation between neighbouring authorities

4. Sex Education Forum www.ncb.org.uk/sef

5. Sex Education Forum www.ncb.org.uk/sef Where are they? High concentration in both rural and urban areas (Northumberland, Staffordshire, Bristol, York) Low concentration in other rural and urban areas Variation between neighbouring authorities Variation within one authority Where service provision is planned strategically and coordinated across the authority there is more consistency

6. Sex Education Forum www.ncb.org.uk/sef

7. Sex Education Forum www.ncb.org.uk/sef FE & sixth form colleges FE or sixth form college is the destination for 4 in 10 young people leaving school 72% of FE & sixth form colleges have on-site sexual health services (in a sample covering 100% of mainstream colleges) 64 colleges offer specialised services including a wide range of contraception and STI testing 106 colleges do not offer any sexual health services 13 local authority areas with no services in FE

8. Sex Education Forum www.ncb.org.uk/sef

9. Sex Education Forum www.ncb.org.uk/sef Models of provision Outreach from local agencies Extension of school/college nurse role Partnership with youth service School/college staff trained by Primary Care Trust Dedicated on-site facilities, clinic-in-a-box, health buses Part of multi-agency holistic health services Linked with c-card scheme/chlamydia screening From basic – specialised sexual health services

10. Sex Education Forum www.ncb.org.uk/sef Do on-site services work? Evidence that better access to contraception leads to reduction in teenage conceptions (Santelli, 2007) Evidence that SRE and access to services reduces teenage conception rates (DfES, 2006) Evidence of high usage of services by vulnerable young people (UWE, 2008) Services in education settings are one piece of the jigsaw

11. Sex Education Forum www.ncb.org.uk/sef Explaining why on-site School is a place that most young people go everyday Lack of opportunity to use other local services Friendly and non-clinical young-people centred environment More barriers accessing testing and contraception than accessing advice Discrete and confidential Get help with problems early Learning opportunity: using a health service is a skill for a lifetime “I’ve got a clinic – round the corner from my house but because it’s right next to my doctors I don’t wana go there. If my mum sees me I think she will kill me.”

12. Sex Education Forum www.ncb.org.uk/sef Headlines June 2008 “School sex clinics fuel debate on promiscuity” (Observer) “Three cheers for the news that nearly one in three secondary schools are now running sexual health clinics for pupils” (Miriam Stoppard, The Mirror) “Give kids guidance… not just the pill” (Sun)

13. Sex Education Forum www.ncb.org.uk/sef Government backing Extended Schools Healthy Schools You’re Welcome Quality Criteria Children’s Plan 2007 committed to: “increase young people’s knowledge of effective contraception and improve their access to advice through encouraging the provision of on-site sexual health services in schools, colleges and youth centres”

14. Sex Education Forum www.ncb.org.uk/sef Ministerial support The Minister for Children and Young People, Beverley Hughes said: “I fully support the many secondary schools which are seeing the value of providing their students with on-site health advice and services. They can help tackle key public health concerns, such as teenage pregnancy, sexually transmitted infections, smoking, binge drinking and obesity, and also improve attendance and attainment by quickly addressing concerns that may have a negative impact on learning."

15. Sex Education Forum www.ncb.org.uk/sef Ministerial support Dawn Primarolo - Minister of State for Public Health, said:   “Further education colleges can play a huge role in providing sexual health advice and help... as well as improving access to contraception, further education also has a key role to play in reducing sexually transmitted infections, particularly through providing chlamydia screening and wider health promotion messages’.

16. Sex Education Forum www.ncb.org.uk/sef How will we know its working? Number and profile of young people using the service: can take time to establish trust Reason for using the service: shift from emergency to prevention Onward referral to other services Improved sexual health outcomes Challenges in evaluation: variation between services – what should the indicators be?

17. Sex Education Forum www.ncb.org.uk/sef A quality service Do all young people feel welcome: gender, age, sexual orientation, disability? Is the service used by young people at high risk of poor sexual health outcomes? Are non-users of the service consulted? Do students understand how, when, where, why to use the service? Do staff know about the service and support referral? Is there a full range of services on offer?

18. Sex Education Forum www.ncb.org.uk/sef Involving young people Service design: branding, location, opening hours, privacy Awareness: promotion in and out of SRE Ongoing monitoring: service users and non-users Peer mentors and service advocates “I think schools should tell them that it’s confidential… Its just shocking – these tests are free and why ant no one using them?”

19. Sex Education Forum www.ncb.org.uk/sef Examples…FE “Information about testing is included on USB ‘pen drive’ given to all new students.  I do tutorials on sexual health to as many of the students that I can, A lot of staff still fear talking about sex to students. ” (College Nurse, North Devon College)   “Here at Durham we advertise Chlamydia testing through posters and tutorials but we also promote through ‘healthy bytes’, all student e mail, Blackboard and all staff e mail”. “We always carry out the screening in areas that the students use or walk through a lot e.g. main foyer and this has worked very well. Last year was our first year of screening and we screened over 300 students”. (Bournemouth & Poole College)

20. Sex Education Forum www.ncb.org.uk/sef Examples…schools “We got some of the students who attended the drop-ins to do a display about Chlamydia in Feb. for St.Valentines day” (Newcastle schools) “Opportunistic testing is done by the school nurse in their sexual health drop ins for those young people at risk. The urine or swab is also tested for gonorrhoea with the young persons consent” (Hull schools) ‘Time4U’ service across a range of settings: schools, colleges, youth centres. Chlamydia testing is part of the minimum offer at each Time4U. Includes 13 secondary schools and a total of 25 venues across Worcestershire.

21. Sex Education Forum www.ncb.org.uk/sef “I didn’t know that Chlamydia could stay inside you for a year before signs show its effects….I was really shocked – and surprised - I was actually angry that I didn’t know this before”. College student

22. Sex Education Forum www.ncb.org.uk/sef Young people’s SRE charter

23. Sex Education Forum www.ncb.org.uk/sef We need to learn…

24. Sex Education Forum www.ncb.org.uk/sef Messages young people get from health workers “Almost an over assumption that young people are involved in sexual activity and more of a focus on safe sex from a physiological point of view than from an emotional and social point of view” “definitely the best of all...non judgmental, understanding and helpful wherever they can be” “good generally if they are pitched at the right level (and the right sexuality, i still receive information as if i have heterosexual sex!)” “good but to late” “good very good if they can talk in our language”

25. Sex Education Forum www.ncb.org.uk/sef “Health workers need to be more visible in schools and make themselves and others aware they are available and easy to talk to” “Health workers often put a very biological slant on the whole sex issue which i feel in some ways is very important but also i feel they should also emphasise the emotional side of it more”. “I've never discussed anything with a health worker”. “I had a very good youth worker who came into my school 6th form once a week, he was friendly informative and made learning easy and fun, You would learn facts about STI's without even realising it as you sat around chatting with him”.

26. Sex Education Forum www.ncb.org.uk/sef Your questions…

27. Sex Education Forum www.ncb.org.uk/sef Resources Case-studies on-line FAQs on-line Email network free to join Forthcoming resource pack Spring 09 networking events Visit: www.ncb.org.uk/sexualhealthservices

28. Sex Education Forum www.ncb.org.uk/sef References click icons for web link… DfES (2006) Teenage Pregnancy Next Steps: Guidance for local authorities and primary care trusts on effective delivery of local strategies. Salmon, D and Ingram, J (2008) An Evaluation of Brook Sexual Health Outreach in Schools. Bristol: Centre for Public Health Research, University of the West of England. Santelli, J and others (2007) Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use’, American Journal of Public Health (January), vol. 97, no. 1: 150-6. Sex Education Forum, (2008) National mapping survey of on-site sexual health services in education settings: provision in schools and pupil referral units in England, NCB. Sex Education Forum, (2008) National mapping survey of on-site sexual health services in education settings: provision in FE and sixth form colleges, NCB. Sex Education Forum, (2008) Young People’s SRE Charter.