Young People s Sexual Health Services Pathways for Practitioners In Cambridgeshire vember 2013
Background Sexual Health and Contraceptive Services for young people operate in different settings and organisations including local authority, health and voluntary sector Legal Framework Any work with children and young people must ensure that the local child protection policy and Fraser Competencies are adhered to by all staff The pathways in this document provide a quick reference for anyone working with young people on issues around sexual health to help them provide appropriate and consistent messages and to signpost young people to appropriate services The Pathways A young person has had unprotected sex A young person requests Emergency Contraception Pregnancy Testing Post Conception Choices Sexually Transmitted Infections Condom Distribution C-Card vember 2013
A young person has had unprotected sex Emergency Hormonal Contraception (EHC) Can be taken take up to 72 hours after unprotected sex Most effective in first 24 hours. Free from a health professional and some pharmacies Can be purchased in pharmacies Should not be seen as a regular form of Encourage pregnancy test 3 weeks after taking emergency IUD can be fitted up to 5 days after unprotected sex. Available from health professionals Free pregnancy test For details of where to access free pregnancy tests go to www.sexualhealthcambs.nhs.uk Result Negative Encourage access to services www.sexualhealth cambs.nhs.uk And C-Card www.ccardcambs. com Result Positive options include: *Parenthood *Abortion/ termination *Child parented by someone else See Post conception choices flowchart Promote use of condoms www.ccardcambs. com Sexual Health Screening Encourage access screening for sexually transmitted infection (STI) www.sexualhealth cambs.nhs.net and Chlamydia Screening www.cambstakeat est.com Offer advice on avoiding STIs in future Child Protection There is no automatic requirement to break confidentiality or report sexual activity as a safeguarding issue Is the young person Fraser competent? For more information see LSCB Working with Sexually Active Under 18 year olds www.cambsls cb.org.uk For details of services providing emergency go to www.sexualhealthcambs.nhs.uk 3
A Young Person Requests Emergency Contraception Had Unprotected Sex in last 72 hours? YES NO Over 16? Had unprotected sex within the last 7 days? NO YES YES NO Is she Fraser Competent? NO YES Issue Emergency Contraception or signpost to GP or Contraceptive Clinic GP or Contraception Clinic may be able to prescribe emergency out of license or fit a coil Help to access pregnancy test Contact Designated Child Protection Person or Line Manager Keep Emergency Contraception as an option Offer Chlamydia Screening or signpost to www.cambstakeatest.com 4
Pregnancy Testing Under 16 Over 16 Is she aware of service confidentiality statement? Can she be persuaded to tell a parent, carer or other significant adult? Discuss why she thinks she is pregnant and assess likely reactions to a positive or negative test Arrange appropriate appointment Establish date of last period. Is it an appropriate stage of the cycle to do a test? Offer to meet her with the adult Offer her a Chlamydia test or signpost Is she happy with the result? Do pregnancy test Is the result positive? Discuss why she wants a baby Retest in 2 weeks if no period Offer support and information Offer another appt. Offer her a Chlamydia test or signpost Discuss STI s, Contraception Offer information on where to get further help Offer her a Chlamydia test or signpost Encourage her to tell another adult who can support her Encourage her to think about her options Offer other sources of help and support Offer another appointment Offer her a Chlamydia test or signpost 5
Post Conception Choices Young person, their partner or previous sexual partner is pregnant Identify appropriate worker who they trust Consider options and choices Ensure the young person has support with decision making throughout the process and after a decision has been made Options Abortion/termination Referral from GP or sexual health clinic. See www.sexualhealthcambs.nhs.uk Make appointment as soon as possible Offer support after abortion Continue with pregnancy See GP/midwife and start taking folic acid as soon as possible Midwife to complete notification form to ensure appropriate support throughout the pregnancy If chose to continue with the pregnancy then adoption contact local social care team to ensure support is offered Consider access to Counseling Support Advocacy and advice Healthy lifestyles Sexual health Information on accommodation, benefits etc www.youthoria.org Any child protection concerns for the young person and/or baby follow LSCB policy and procedure Working with sexually active young people under the age of 18 (http://www.proceduresonline.com/cambridgeshire/scb/pdfs/g_wrk_sex_active_yp.pdf) 6
Sexually Transmitted Infections Does he/she have any symptoms e.g., pain, discharge, rash? Advise him/her to be seen at a GUM Clinic, GP Surgery, Family Planning or Young Person s Clinic or GP for full screen Give leaflet See www.sexualhealthcambs.nhs.uk for local clinics and to book an appointment Offer a Chlamydia test or signpost Carry out risk assessment Is he/she high risk? Explain options and ask whether he/she has still got concerns He/she might want full screen Advise him/her to be seen at a GUM Clinic, GP Surgery or Young Person s Clinic or GP for full screen Give leaflet 7
Condom Distribution C-Card Talk to young person 1:1 Introduce service confidentiality statement Under 16 Over 16 Advise them to discuss with a parent or other significant adult Carry out risk assessment Inform Child Protection lead if appropriate Deliver R U Ready advice if appropriate Inform YP if sharing information and discuss with them Are they Fraser Competent? Do condom demonstration Is there a real likelihood of the young person having sex? Give information on Emergency STIs Other forms of if appropriate Offer a Chlamydia test or Do condom demonstration Do condom demonstration Give information on Emergency STIs Other forms of if appropriate Offer a Chlamydia test or signpost Issue C-Card and condoms Provide limited number of condoms to support education Provide limited number of condoms and consult safeguarding lead 8
Further sources of support and information THE C-CARD (Condom Card Scheme) The C-Card allows young people aged 19 and under to collect free condoms from any place displaying the C-Card logo in Cambridgeshire. This registration process supports the young people to have an opportunity to think about whether they are really ready for sex. It also goes through correct condom use with them. C-Card registration and pick up points as well as more information on this scheme can be found at: www.ccardcambs.com Chlamydia Screening Programme Details about the local Chlamydia screening programme and details of where young people can get tested http://www.cambstakeatest.com/testing.html Youthoria Website for young people living in Cambridgeshire, including information on relationships and sexual health and details of local sexual services www.youthoria.org DHIVERSE Local Sexual Health and HIV charity in Cambridgeshire www.dhiverse.org.uk SexYOUality Local charity offering support to young people exploring their sexuality. Support groups for gay, bisexual and lesbian young people www.2byouth.co.uk 9