Presentation Transcript

1. The sexual health needs of Looked After Young People: Service providers’ views and responses – findings from Scotland and Ireland

   Deirdre Fullerton Insights Health and Social Research
2. Overview of Presentation Summary of key research (International Research) Deirdre Fullerton (in Prep) The Sexual Health Needs of Young People in Care – A review of the research evidence. Views of Service Providers (Ireland) Fullerton, Hyde et al (2013) SENYPIC – Report 1 - Findings from Research with Professionals and Service Providers Report to HSE CPP Descriptive Mapping of Approaches (Scotland) Burtney E & Fullerton D (2011) Descriptive mapping of sexual health improvement interventions in Scotland. Health Scotland/Scottish Government
3. Some Key Scottish Papers Research Papers Dale (2009) Dale et al (2010) The Sexual Health Needs of Looked After Young People NHS Fife Nixon C (In Prep) Comparing risk behaviour, SRE needs and experiences of LAYP in foster and residential care. (CSO funded PhD Fellowship – SPHRU Glasgow) Henderson et al (2011) Vulnerable young people in alternative education settings: their sexual health needs, experience and use of sex education and sexual health services SPHRU Glasgow Dixon. J., Stein, M. (2002) Still a Bairn: A Study of Through-care and Aftercare Servicesin Scotland. Scotland’s Children Research Scottish Executive. Briefing Papers Paterson M and Windsor S (2011) Supporting sex and relationships education for looked after children and young people: a briefing paperWish Health Scotland Celcis(2013) Written Evidence for the Scottish Parliament Health and Sport Committee: Inquiry into Teenage Pregnancy Sutherland M (2009) Supporting Lesbian, Gay, Bisexual and Transgender young people in residential care SIRCC
4. Other Relevant Research Ireland SENYPIC Study England Chase et al (2008) Knight et al (2006) Billings et al (2007) Barn and Mantovani (2007) Corylon and McGuire (1999) USA Robertson RD (2013) Literature Review

5. Key Findings – National and International Research

6. Context Children who are in care are widely recognised as being more socially excluded and vulnerable to poor health and social outcomes than the most disadvantaged children outside the care system (Meltzer et al 2003; Biehal et al 1995).
7. Many young people in care experience: early school leaving (Gilligan et al 2000) and lower educational achievements (Scottish Parliament Education and Culture Committee 2012) early school leaving and disengagement from school associated with risk of poor sexual health generally (Arai 2003) and in young people in care (Bain and Mantovani 2007, Billings et al 2007). social and educational disadvantage and exclusion (Dale 2011, Biehal 1995) social exclusion increases young people’s risk of poor sexual health outcomes (Bonell et al 2003). disruption in placements (Billings et al 2007). Poor school attendance is associated with missed sex education for YPIC (Corlyon and McGuire 1999)
8. Young People in Care and Risk Family background both a risk and protective factor that influences age of sexual intercourse and teenage conception (Bain and Mantovani 2007) Family trauma, poor adult role modelling, domestic, physical and sexual abuse Lack of family connectedness/Absence of biological parent(s) Poor family support post care Emotional and mental health problems /poor self esteem also associated with higher risk of poor sexual health (Emler 2001, Bain and Mantovani 2007)
9. Risk behaviours Some young people in care are more vulnerable early risk taking (Dale et al 2010, Meltzer et al 2003, Jones et al 2010; Jones et al 2010) Sexual exploitation (Cusick 2002, Pearce 2009) Predictive factors Low self esteem, loneliness, mistrust of others, lack of assertiveness, perceived lack of options (Haydon 2006, Berrington 2005) Gaps in knowledge and awareness of sexual health services (Dale et al 2010, Scott & Hill 2006)
10. Teenage Pregnancy and YPIC Research from USA/England indicates that young people in foster care are 2.5 times more likely to become pregnant by 19 (Becker and Barth 2000, Dworsky & Courtney, 2010; Chase et al 2008) Parenthood can be a positive choice for some YPIC (Chase 2008) Need for affection/family – Sense of purpose Young parents from care background experience additional support needs (Pryce et al 2010) Lack of readiness for parenting Lack of family support
11. Specific needs Young men in care (Gelder 2006) Young fathers Young people with disabilities in care – particularly learning difficulties LGBT young people in care may experience additional support needs to deal with homophobia (Sutherland 2009) Evidence of greater riskier behaviours (weapon carrying, substance misuse, risky sexual behaviour) Unaccompanied minors
12. Sexual Health Needs of LAAC – Views of Service Providers/stakeholders Previous Research with Service Providers Chase et al (2008) England Qualitative study of 78 professionals (coordinators, managers, caseworkers, residential care workers, foster carers, staff in supported housing and education) Constantine et al. (2009) USA Survey and interviews service planners, providers , foster carers and young people Love et al (2005) On line survey with foster carer stakeholders (USA)

13. The Views of Service Providers - Ireland

14. SENYPIC RESEARCH Collaborative study between UCD, Insights, QUB Funded by HSE Crisis Pregnancy Programme The study involves a number of discrete, but interrelated stages using a mixed methods approach.
15. E-Survey: Services and Organisations(n=118) • HSE Social work (Residential, Foster and Aftercare)• Foster care organisations• Specialist services for Young Care Leavers • Education and training e.g. Schools, Youthreach, CTC • Generic Youth services• Youth Health Services (general and specialist services)• Health promotion  • Homeless organisations • Services to early school leavers • Primary care (GP, Practice Nurse, Public Health Nursing) • Specialist services providing support for pregnant and/or parenting teenagers• Training and workforce development organisation • Advocacy organisations• Research organisation 
16. Sexual Health Needs of LAAC Young people in foster care and residential care have additional SRE education Diversity across the category of young people in care School/placement history Type of care – Kin care, foster care, residential , secure Background issues - Experience of abuse, history of emotional trauma, security of family, attachments Inconsistent peer groups Learning difficulties/disabilities History of poor supervision (e.g. access to media age inappropriate context) LAAC need for love and affection High risk behaviours – poor decision making, inability to discriminate healthy relationships/using sex as coping strategy
17. Challenges to Delivery of RSE and Sexual Health Work Organisational and Policy factors Lack of clear Sexual Health Policy in HSE Ethos of organisation State/Church Concerns about Legal Issues Underage sex – child protection issues Lack of Resources To provide training for staff To delivery RSE programme to young people Inconsistency in RSE delivery In schools/Residential settings Poor access to sexual health services Competing pressures No time to focus on individual needs – pressure to comply with national standards only Children with multiple problems – sexual health needs get pushed aside
18. Support needs of staff A culture/ethos which is supportive of the provision of RSE Clear policy RSE programmes specially for LAAC Staff skilled to deliver RSE Workforce development RSE in professional training Regular training for all relevant staff Training to explore own beliefs and values Legal aspects on consent and the law Guidance on crisis pregnancy How to support teenage pregnancy Specialist services RSE for unaccompanied minors Young people with learning disabilities Young people displaying inappropriate sexual behaviours

19. Responding to the Sexual Health needs of Young people in Care

    Examples from Scotland – from Descriptive Mapping Study 2011
20. Policies Wish Briefing paper provides a very good overview of relevant policies GIRFEC – Outcomes Single outcome agreements NHS Greater Glasgow Policy /Guidance and Toolkit NHS Forth Valley – Policy and guidance for Staff
21. Approaches to sex education Specialised sex education programmes Health Promoting Units (All Residential care units – Edinburgh) Truth on Teenage Sex TOTs (Ayrshire and Arran Scotland) Princes Trust Programme (Dumfries and Galloway) Information, Self esteem work, Links to Services Real Care Programme (Glasgow) Teen Pregnancy Prevention - Covers contraception, STI and parenting Dundee – Web project Sex education in variety of venues Caledonia Youth Work with residential care settings – links to clinical services
22. Sexual Health Services One to one advice – across a range of health behaviours Health Consultancy Project Fife One to one behaviour change MYPAS Lothian Drop-in and outreach for LAAC Improved access to clinical services Glasgow Sexual Health Needs Assessment within Local Integrated Assessment and Planning - link to C-card scheme LAAC nurses – Identify and respond to needs Fast track to clinical services
23. Supporting Carers Speak Easy / Talk 2 programmes tailored to specific needs of foster carers Health Consultancy Project Fife Carers receive guidance and advice on working with LAAC on sexual health Multidimensional Treatment for Foster carers (MTFC) RCT Evidence from USA 40% reduction teenage pregnancy Pilot study in UK including one site in Scotland
24. Therapeutic Approaches Health Opportunities Team (Edinburgh) Overcoming Trauma/Turn around Sexual Health Programme Social Pedagogic approaches (not sexual health focused) Residential care and foster care pilots in Scotland
25. Teenage Parents in Care Teenage parents support projects FNP Pilot Tailored support for vulnerable parents
26. Other initiatives England Carmen Project – Peer Mentoring
27. Summary Young people in care are likely to have Gaps in their knowledge Begin sexual behaviour earlier/take sexual health risks/vulnerable to exploitation Become teenage parents earlier/have less support to parent No data on the numbers in Scotland LGBT from care background have additional support needs No data on numbers in Scotland Research from USA/Ireland indicate staff/carers require additional support to meet the RSE needs of young people in care via policy/training and services Positive examples in Scotland Policies RSE provision Access to Sexual Health Information and Services Support for foster carers Therapeutic approaches
28. More information? deirdre@insightsresearch.co.uk
29. Dale H, Watson L, Adair P, Moy M, Humphris G (2010) The perceived sexual health needs of looked after young people: findings from a qualitative study led through a partnership between public health and health psychology. Journal of Public Health Mar;33(1):86-92. Epub 2010 Aug 5.. Dale, H. (May, 2009) The Sexual Health Needs of Looked After Young People NHS, Fife Knight, A., Chase, E., & Aggleton, P. (2006). Teenage pregnancy among young people in and leaving care: Messages and implications for foster care. Adoption and Fostering,30, 58–69. Sutherland M (2009) Supporting Lesbian, Gay, Bisexual and Transgender young people in residential care. Scottish Institute for Residential Child Care Teenage Pregnancy Unit (2001) Guidance for field social workers, residential social workers and foster carers on providing information and referring young people to contraceptive and sexual health services. Department of Health, London.