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1 Enabing young peope to access contraceptive and sexua heath information and advice: Lega and Poicy Framework for Socia Workers, Residentia Socia Workers, Foster Carers and other Socia Care Practitioners

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3 Content The Context 3 11 Section One: The ega and poicy framework for socia workers, residentia socia workers, foster carers and other socia care practitioners on enabing young peope to get contraceptive and sexua heath information and advice Section Two: The roe of heath professionas in providing contraceptive and sexua heath information, advice and treatment Section Three: A checkist of actions for socia workers, residentia socia workers, foster carers and other socia care practitioners to support impementation of the guidance in the context of their oca teenage pregnancy strategy Annex A Legisative and Poicy Framework Annex B Socia Care Practitioners Guidance Working Group 36 Annex C Usefu Organisations Annex D References

4 The ega and poicy framework for socia workers, residentia socia workers, foster carers and other socia care practitioners on enabing young peope to access contraceptive and sexua heath information and advice THE CONTEXT This document sets out the ega and poicy framework for socia workers, residentia socia workers, foster carers and other socia care practitioners on providing information and referring young peope to contraceptive and sexua heath services. For the purpose of this document, the term young person refers to ooked after chidren, chidren in need, vunerabe chidren, care eavers or any young person that socia services may come into contact with. The term socia care practitioner refers to a socia workers, residentia socia workers, foster carers and socia work assistants. The Teenage Pregnancy Unit (TPU) and Quaity Protects pubished the first edition of this guidance in 2001 (Guidance for Fied Socia Workers, Residentia Socia Workers and Foster Carers on providing Information and Referring Young Peope to Contraceptive and Sexua Heath 1 ). The TPU guidance was issued as an action point of the Government s Teenage Pregnancy Strategy 2 to address the high incidence of teenage pregnancy amongst ooked after young peope and other vunerabe groups in contact with socia care practitioners. However, many socia care practitioners remain uncertain about what their roe aows them to do within the ega and poicy framework. In addition, concerns have arisen about the impications of the Sexua Offences Act This revised guidance has been written to refect changes in egisation and to address those concerns. Simiar guidance wi aso be made avaiabe for Youth Support Workers. Guidance to heath professionas 4 on the provision of contraceptive advice and services to under 16s has aso been updated. These can be obtained from the TPU or downoaded from the TPU and Department of Heath (DH) websites 3

5 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas The vita roe of a socia care practitioners in supporting young peope to access contraception and sexua heath information and advice shoud be activey encouraged. This shoud be done within a broader sex and reationships programme which heps young peope deveop assertiveness and negotiating skis to hep them make positive choices about their persona reationships and resist pressure to have eary or unwanted sex. The duty of a socia care practitioner, irrespective of their persona view, is to promote and safeguard the heath and wefare of a young peope regardess of sexua orientation or preference. With this in mind, the support provided shoud be appropriate to the young person and their individua needs. This incudes supporting young peope s eary uptake of contraception and access to confidentia sexua heath advice if and when they become, or are thinking about becoming, sexuay active. Providing a timey ink into services can make the difference between a young person making safe, informed choices or facing an unpanned pregnancy or a sexuay transmitted infection. The TPU guidance aims to carify for socia care practitioners: that young peope in their care have the same right to confidentia contraceptive and sexua heath information and advice as other teenagers; that young peope who are, or are thinking about becoming sexuay shoud be encouraged to seek sexua heath and contraceptive advice, have any of their concerns about confidentiaity addressed and shoud be directed to oca services; the roe they can pay in providing information and advice about contraception and referring young peope to appropriate services and; the roe of heath professionas in providing these services to young peope. Ownership of Framework Document This framework document is issued by the TPU and the Looked after Chidren Poicy Branch within the Department for Education and Skis (DfES), and DH. It has been deveoped and agreed by the Socia Care Practitioner s Guidance Working Group, which represents a number of key stakehoders (List provided in Annex B). The document wi be reviewed annuay by the Working Group and revised as necessary. 4

6 The Context Status of Framework Document The Government guidance Working Together to Safeguard Chidren 5 states that poice shoud aways be informed where a crimina offence is known or suspected to have been committed against a chid. Athough the age of consent remains at 16, it is not intended that the aw shoud be used to prosecute mutuay agreed teenage sexua activity between two young peope of a simiar age, uness it invoves abuse or expoitation. However, the younger the person, the greater the concern about abuse or expoitation. It is therefore expected that oca poicies and protocos wi refect the need for socia care practitioners to use their discretion in weighing up the circumstances of each individua case to determine whether a forma notification to the poice is necessary. Poicies which require automatic forma notification to the poice may stop young peope confiding in socia care practitioners, incuding those young peope most at risk of abuse. It is important to recognise that the poice may hod information about individuas who pose a danger to young peope, which is not necessariy known to other agencies. Poicies and protocos shoud therefore incude arrangements for informa, anonymous discussion with the poice about cases of concern, to inform a decision about making a forma referra. Further guidance wi be issued by Apri 2006 under the Chidren Bi, on Loca Safeguarding Chidren Boards. This guidance wi aso incorporate revisions to Working Together to Safeguard Chidren. Format of Framework Document This guidance is set out in three sections: 1. The ega and poicy framework for socia workers, residentia socia workers, foster carers and other socia care practitioners on enabing young peope to get contraceptive and sexua heath information and advice; 2. The roe of heath professionas in providing contraceptive and sexua heath information advice and treatment; and 3. A checkist of actions for socia workers, residentia socia workers, foster carers and other socia care practitioners to support impementation of the guidance in the context of their oca teenage pregnancy strategy (see next section). 5

7 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas What is the Teenage Pregnancy Strategy? Aim of Strategy In 1999, the Government aunched a 10-year, cross-government Teenage Pregnancy Strategy 2 from the Socia Excusion Unit. Two goas have been set: To have the rate of conceptions among under 18s in Engand by 2010 with an interim target of 15% by 2004 and to set a firmy estabished downward trend in conceptions among under 16s; and To reduce the risk of ong term socia excusion for teenage parents and their chidren by increasing to 60% the participation of teenage parents in education, training and empoyment. Four key strands of the Strategy A efforts at a nationa, regiona and oca eve are panned and impemented through the foowing four strands: Joined up action; Nationa media campaign for young peope and parents; Prevention (improved sex and reationships education (SRE) and access to sexua heath and contraception services); Support for young parents. Regiona and oca impementation of Strategy Every top tier oca authority area has a 10-year teenage pregnancy strategy in pace, deveoped jointy with education, heath, socia services and other reevant partners, which has been agreed by the Teenage Pregnancy Unit. A Teenage Pregnancy Loca Impementation Grant is paid to every top-tier oca authority. The grant supports the impementation of oca teenage pregnancy strategies, through the pump-priming of promising practice and new approaches, and ensures that robust arrangements are in pace for the co-ordination and deivery of agreed oca action pans. Each strategy is ed by a Loca Teenage Pregnancy Co-ordinator and Teenage Pregnancy Partnership Board. The Board incudes representatives from socia services, Connexions and other key oca authority and heath partners. The oca Teenage Pregnancy Co-ordinators are supported by a network of Regiona Teenage Pregnancy Co-ordinators based in the Government Offices. Loca areas submit annua reports and action pans at the end of March each year and review meetings are conducted by Regiona Teenage Pregnancy Co-ordinators in the autumn of every year. The reports and action pans are assessed by regiona assessment panes and written 6

8 The Context feedback is given by the Regiona Teenage Pregnancy Co-ordinator and the TPU. Regiona assessment panes are composed of a number of regiona agencies which refect the cross-cutting nature of the Teenage Pregnancy Strategy 2. This incudes those with responsibiity for performance management such as Performance Managers in Strategic Heath Authorities, the Commission for Socia Care Inspection, and regiona housing coeagues. Representatives from key programmes such as the Heathy Care Programme, Connexions, and Sure Start are aso on the pane. The assessments of the annua reviews are added to the Performance Assessment Data and Information (PADI) database, a too through which socia care coeagues performance assess socia services, so that the information can be accessed by Socia Services Inspectors. Why is the Strategy Necessary? The UK has the highest teenage birth rate in Western Europe three times as high as France and six times the rate in the Netherands 2. Whie other countries have achieved significant reductions in teenage pregnancy rates during the 1980s and 1990s, the UK rates have remained static. Athough many young parents manage extremey we, teenage births carry increased heath risks for the young women and their babies. Teenage parents are aso more ikey than oder parents to ive in poverty and to be unempoyed. Of a teenagers who conceive, 50% of under 16s and more than a third of year ods have abortions 2. In addition to high conception rates in the UK, at east 10% of sexuay active teenagers are estimated to have a sexuay transmitted infection and chamydia rates are increasing fastest among year od women. The Government s Sexua Heath and HIV Strategy 6 for Engand, pubished in Juy 2001, seeks to reduce these rates. For more information Visit the TPU website at: How does the strategy aim to achieve its goas? Around three-quarters of teenage births and the vast majority of teenage pregnancies that end in abortion are unpanned. Over two-thirds of young peope visit sexua heath/contraceptive services after first sex. Athough the percentage of young peope using condoms at first sex is increasing, many continue to use contraception erraticay. Under 16s are the group east ikey to protect themseves. The Teenage Pregnancy Strategy 2 aims to hep young peope: resist peer pressure to have eary sex; and use contraception if and when they decide to become sexuay active. 7

9 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas This is being done through a combination of: a nationa media campaign for young peope in teenage magazines and oca radio; improved SRE in schoos; the provision of effective contraception and sexua heath services which are trusted by young peope; and support for parents in taking to their chidren about sex and reationships. WHY DO SOCIAL CARE PRACTITIONERS NEED TO HELP YOUNG PEOPLE SEEK EARLY CONTRACEPTIVE AND SEXUAL HEALTH ADVICE? A young peope are highy diverse and it is important to recognise that they each have their own individua needs, abiities, beiefs, hopes and expectations. This appies equay to young peope who come into contact with socia services, especiay care eavers. However, the needs and concerns of this group are compounded by the compex circumstances resuting from their pre-care experiences, their experiences of being in care, and the combination of disadvantages which affect access to opportunity. As a resut, these young peope may experience significant heath inequaities and very poor heath, education and socia outcomes which may seriousy affect their abiity to reach their fu potentia. Research in the United Kingdom and in other countries shows that young peope with a history of disadvantage are at a significanty greater risk of becoming parents in their teens. Young peope in contact with socia services are ikey to be disproportionatey affected by the foowing risk factors. It is therefore of particuar importance that socia care practitioners are mindfu of teenage pregnancy issues when working with young peope with the foowing risk factors. Living in Poverty The risk of becoming a teenage mother is amost ten times higher for a gir whose famiy is in socia cass V (unskied manua), than those in socia cass I (professiona) 7. Teenage girs who ive in oca authority or socia housing are three times more ikey than their peers iving in owner occupied housing to become a teenage mother 7. Having been in Care A study of ooked after young peope found that a quarter of young women had a chid by the age of 16 8 and neary haf were mothers within months after eaving care 9. 8

10 The Context Educationa Probems A recent Office of Nationa Statistics (ONS) study found that ony 44% of ooked after young peope eft care with at east one GCSE or GNVQ, compared to 96% of Year 11 pupis 10. Low educationa attainment among boys and girs, truancy and schoo excusion are strongy associated with teenage pregnancy. One piece of research of 50 girs excuded from schoo showed that 14% had become pregnant during their period of excusion 2. Not being invoved in Education, Training or Work post 16 There is evidence of a strong ink between teenage parenthood and not being in education, training or work, for 16 and 17 year od women. In one study amost haf of non-participants were mothers, compared with 4 percent who were in education, training or work. Further anaysis suggested that about a third had become pregnant whie not in education, training or work 11. Experience of Abuse Severa studies have shown an association between chidhood sexua abuse and teenage pregnancy 2. Current ooked after chidren statistics 12 show that of 59,700 chidren in care 62% are estimated to have been abused or negected Experiencing Menta Heath Probems A recent study 13 indicates that 45% of ooked after chidren and young peope aged 5-17 were assessed as having a menta heath issue: 37% a conduct issue; 12% emotiona issues incuding anxiety and depression. In troube with the Poice One study showed that teenage boys and girs who have been in troube with the poice had twice the risk of becoming a teenage parent 2. An estimated 25% of young men under 21 in Young Offenders Institutions are fathers or expectant fathers. These young men often have ow sef-esteem and ack the necessary skis and confidence to deveop and manage rewarding and safe persona reationships. They may have experienced inadequate parenting and adut roe modes and have missed out on SRE in mainstream schooing. 9

11 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Other areas for Consideration Socia care practitioners shoud aso be mindfu of the sexua heath needs of unaccompanied asyum seeking chidren (UASC) and the difficuties they experience in accessing information and advice. There are an estimated 8,000 unaccompanied asyum seeking chidren in the UK; the majority are 16 and 17 year ods. As chidren in need, UASC are supported under Section 17 or 20 of the Chidren Act It is accepted that this group are vunerabe to stress and emotiona probems reated to their particuar experiences. Experiences of acute stress and distress to this group of chidren and young peope incude: vioence, incuding torture and sexua vioence; oss and bereavement; sudden change; injustice; absence of supportive reationships; extreme poverty and deprivation; persecution; dispacement; and uncertainty about their future. These experiences might have occurred in the country they have fed from, during their journey to the UK or on arriva in the UK. The existing needs of this group are considerabe and their experiences on arriva in the UK may further compound and isoate the young person. The young person may speak itte or no Engish which may act as a barrier to accessing sexua heath information and advice. The Roe and Duty of Socia Care Practitioners in supporting Young Peope to Access Contraception and Sexua Heath Information and Advice The vita roe of a socia care practitioners in supporting young peope to access contraception and sexua heath information and advice shoud be activey encouraged within a broader sex and reationship programme which heps young peope deveop assertiveness and negotiating skis to hep them make positive choices about their persona reationships and resist pressure to have eary or unwanted sex. 10

12 The Context A socia care practitioners shoud be supported in this work by protocos, deveoped within agreed reationship and sex poicies and impemented through training and ongoing supervision and support. Loca protocos and poicies shoud refect the principes of this guidance which appy to a young peope, regardess of sexua orientation or preference. Legisative and Poicy Framework The underpinning principes of the foowing egisation and poicy are refected in this guidance. Socia services shoud be mindfu of these when deveoping oca poicies and protocos. Detais of the foowing are outined in Annex A. Every Chid Matters, Next Steps 14 and the Chidren Bi Heathy Care Programme Promoting the Heath of Looked After Chidren Guidance 15 The Chidren Act Loca Government Act The European Convention on Human Rights United Nations Convention on the Rights of the Chid 11

13 SECTION ONE The roe of a socia care practitioners on providing information and referring young peope to contraceptive and sexua heath services Providing information about oca contraception and sexua heath services Q.1 How can socia care practitioners find out which oca services to refer young peope to? Each oca teenage pregnancy strategy has deveoped a referra checkist of services for practitioners and service information eafets for young peope. Managers of socia care practitioners shoud contact the oca teenage pregnancy coordinator for copies of pubicity materias and disseminate suppies to a those working with young peope. Detais of oca young peope s services are aso avaiabe on Q.2 If asked by a young person, can socia care practitioners give detais of oca contraception and sexua heath services? Yes. Socia care practitioners can and shoud give young peope information about oca services, incuding detais of opening times, and make sure they are confident in accessing any advice they need. Q.3 If socia care practitioners think a young person is aready sexuay active or ikey to become so, can they proactivey give them detais of oca services without being asked? Yes. If the socia care practitioner thinks a young person is aready, or ikey to be at risk of pregnancy or STIs, they shoud provide the young person with detais of oca services, find out whether they have any worries about seeking advice and offer any further support to minimise risk taking. 12

14 Section 1: The roe of a socia care practitioners Q.4 Can socia care practitioners dispay posters or eafets about oca services? Yes. When working with young peope, it is good practice to dispay the oca teenage pregnancy strategy s pubicity about contraception and sexua heath services. This shoud be aongside heath promotion and service information on other reevant issues such as acoho, drugs, menta heath and persona safety, which can be obtained from the Primary Care Trust (PCT) heath promotion departments or the oca Connexions Service. There may aso be oca websites with service information. Q.5 Can socia care practitioners give young peope information about contraceptive methods and sexuay transmitted infections? Yes. As part of the sex and reationships programme, socia care practitioners can and shoud provide young peope, incuding under-16s, with accurate information about contraceptive methods and STIs. They shoud aways ensure that the information is cear and up to date by checking with the oca contraception and sexua heath services, PCT heath promotion department or a speciaist nationa organisation such as fpa (previousy known as the Famiy Panning Association) or Brook. Socia care practitioners are not heath professionas so they shoud not give advice on which method of contraception to use or on the diagnosis or treatment of specific STIs. Young peope needing to make a contraceptive choice or needing STI advice shoud be supported to visit the oca contraception or sexua heath service. Q.6 Can socia care practitioners assist young peope in accessing emergency contraception? Yes. If they are aware that a young person has had unprotected sex and does not want to become pregnant, they shoud make sure she is fuy aware of emergency contraception and heped to access a oca contraceptive service as quicky as possibe. This is part of socia care practitioners duty to promote and safeguard the heath and wefare of young peope, irrespective of their persona views on emergency contraception. Emergency contraception pis can be taken up to 72 hours after unprotected sex but are most effective in the first 24 hours. An emergency Intra-Uterine device (IUD) can aso be fitted up to five days after unprotected sex. 13

15 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Taking young peope to oca contraception and sexua heath services Q.7 Can socia care practitioners take a group of young peope to visit a oca cinic to find out about oca services? Yes. As part of a wider sex and reationships programme, famiiarising young peope with contraception and sexua heath services can be a very effective way of aaying anxieties and improving eary uptake of advice. In residentia care a doctor, nurse or counseor from a oca cinic coud aso be invited in to expain what the service offers and to answer young peope s questions. This coud be done aongside visits from other community services and organisations. Chidren in foster care coud aso be invited to attend these sessions. Parenta permission woud not be required, but it woud be good practice to consut with and inform parents about the sex and reationships programme. Q.8 Can socia care practitioners accompany a young person to a oca service? Yes. Apprehension about visiting services deters many young peope from getting eary contraceptive or sexua heath advice. If a socia care practitioner beieves a young person is worried about visiting a service and is at risk of pregnancy or STI, they may accompany them to a cinic. Their reationship with the young person may aso hep in reinforcing the advice from the heath professiona after the consutation. Whist accompanying the young person, the socia care practitioner needs to ensure that the young person can see the heath professiona on their own so that confidentiaity is maintained, uness the young person specificay requests that they are accompanied during the consutation. Bringing contraception and sexua heath advice to young peope Q.9 Can socia care practitioners give condoms to young peope under 16? Yes. Singe condoms may be given to under 16s as part of an information session. However, when providing condoms for contraceptive purposes and the prevention of sexuay transmitted infections, it is good practice for socia care practitioners to foow the Fraser guideines. The criteria for the guideines were outined by Lords Fraser and Scarman in 1985, in the House of Lords ruing in the case of Victoria Giick v West Norfok and Wisbech Heath authority and the Department of Heath and Socia Security. These guideines refer to doctors but aso appy equay to other heath professionas 14

16 Section 1: The roe of a socia care practitioners and socia care practitioners. In using these guideines, professionas shoud estabish that the foowing criteria are met: the young person understands the heath professionas advice; the heath professiona cannot persuade the young person to inform his or her parents or aow them to inform the parents that he or she is seeking contraceptive advice; the young person is very ikey to begin or continue having intercourse with or without contraceptive treatment; uness he or she receives contraceptive advice or treatment, the young person s physica and/or menta heath or both are ikey to suffer; and the young person s best interests require the doctor to give contraceptive advice and/or treatment without parenta consent. The suppy of condoms by socia care practitioners shoud be supported by: a sex and reationships poicy which incudes deveoping young peope s skis and confidence to resist pressure to have eary or unwanted sex; cear protocos on condom distribution agreed with service managers, understood by young peope and incuded in the sex and reationships poicy. Protocos shoud incude providing verba and written advice about using condoms correcty, detais of oca services for further advice or suppies, and information about emergency contraception in the event of the condom spitting or not being used; training and on-going access to support, management and supervision; and iaison with oca contraception and sexua heath services to ensure that condoms suppied are in date and carry the British Standard Kite Mark and EC standard. Q.10 Can heath professionas provide a contraception and sexua heath service within a residentia setting? Yes. Bringing a heath professiona into the residentia setting can provide young peope who are reuctant to visit mainstream services with much easier access to confidentia advice and contraceptive suppies. To protect young peope s confidentiaity, it is best to provide contraception and sexua heath advice as part of a genera heath drop in session so the reason for the consutation is not apparent to either peers or staff. This arrangement aso offers young peope support on other important issues such as anxiety, depression, eating disorders and substance misuse. 15

17 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Speciaist ooked after chidren nurses are now empoyed by many PCTs. Looked after chidren nurses and oca teenage pregnancy coordinators are key contacts for initia discussion about bringing services into residentia settings. Young peope shoud aso be cosey invoved to ensure services meet their needs. Taking services out to young peope is one of the recommendations of the Teenage Pregnancy Strategy s Best Practice Guidance on the Provision of Effective Contraception and Advice Services for Young Peope 18. This guidance is avaiabe on the TPU website Pregnancy testing, advice and referra Q.11 Can socia care practitioners do a pregnancy test for a young person? Yes. Fear and denia often deter teenagers from getting an eary pregnancy test. As a resut they are more ikey to miss antenata care and to have ate abortions. If a young person suspects they are pregnant, it is preferabe for them to have a pregnancy test at a oca service. However, if they refuse, the socia care practitioner coud support them in doing a home pregnancy test. Athough home tests are reiabe, it woud be advisabe to have the resut confirmed at a oca service. If the test resut is negative, a visit to the cinic aso provides the opportunity for the young person to discuss future contraception and find a method they are happy with. It is important that young peope are referred to pregnancy testing services which provide non-judgmenta information. Some organisations provide free pregnancy testing but are opposed to abortion. The oca teenage pregnancy strategy service checkist shoud make cear the nature of the service provided by each organisation. Q.12 What shoud socia care practitioners do if the test is positive? The first priority is to make sure the young person has speedy access to a service providing unbiased information on their options of keeping the baby, abortion or adoption. For some, referra for more in depth pregnancy counseing wi aso be necessary. However, it is important that a young women have the time and opportunity to discuss their feeings about the pregnancy and be sure they are making the decision they fee is right for them. Decisions made under pressure to continue the pregnancy or have an abortion can ead to ater regret. When providing support, the socia care practitioner shoud discuss the benefits of informing her birth parents/carer, father of the chid, socia worker or another trusted 16

18 Section 1: The roe of a socia care practitioners adut and encourage their invovement. If required, the socia care practitioner shoud offer the young person specific support in teing her parent(s) or carer. Support shoud aso be offered to a young man in care who has a partner who is pregnant. Q.13 What roe do socia care practitioners pay in supporting onward referra? Whatever choice the young person makes, the socia care practitioner shoud support them to access a heath professiona for onward referra to antenata care or NHS funded abortion. Keeping the baby If the young woman chooses to keep the baby, she shoud be heped to te her socia worker and/or birth parents/carer to discuss future arrangements. A oca teenage pregnancy strategies have a range of support services for young parents aimed at improving the outcomes for them and their babies. If the young woman ives in one of the twenty Sure Start Pus piot areas, she shoud be referred to a Sure Start Pus Persona Adviser who wi hep to broker the advice and support she needs. In other areas, support may be provided from speciaist midwives, heath visitors or Connexions Persona Advisers. Detais of a avaiabe services are avaiabe from the Teenage Pregnancy Coordinator. Comprehensive information about young parent s entitement to benefits and support is outined in the Maternity Aiance Resource Pack 19, Pregnant teenagers and young parents. Socia care practitioners shoud aso ensure that young mothers have access to information and advice about future contraception. It is estimated that between a quarter and a third of births conceived to young women aged 17 and 18 are second pregnancies, many of which are ikey to be unpanned. Having an abortion If abortion is the chosen option, the socia care practitioner shoud ensure the young person has support, both in accessing speedy referra, on the day of the referra itsef and after the procedure. The socia care practitioner shoud aso discuss the benefits of informing her birth parents/carer. If the young person does not wish to inform her birth parents/carer, every effort shoud be made to hep them find another adut to provide support, for exampe another famiy member or speciaist youth worker. To hep prevent a future unpanned pregnancy, they shoud ensure the young woman is heped to access oca heath services to find a method of contraception she is confident to use. 17

19 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Socia care practitioners shoud aso provide information about sources of post abortion support from the oca teenage pregnancy strategy service checkist. Thinking about adoption If the young person is considering adoption, the socia care practitioner shoud support the young woman to access an adoption adviser through the Counci with Socia Services Responsibiities (CSSR) or vountary adoption agency, and provide on-going support as required. Q.14 What about the father of the chid/partner of the young women? Wherever possibe the father of the chid/partner of the young woman shoud be invoved but ony with the consent of the young woman. The fina decision about the outcome of the pregnancy aways rests with the young woman. However, supporting the coupe in making a joint decision can hep to minimise potentia discord or recrimination. Invovement of the father/partner is particuary important if the young woman decides to keep the baby. A positive reationship with the mother during the pregnancy is a key predictor of the father s on-going invovement in the eary years of the chid s ife. THE SEXUAL OFFENCES ACT Q.15 Under the Sexua Offences Act (2003), can socia care practitioners encourage young peope under 16 to seek contraception and sexua heath advice without being seen to faciitate an iega act? Yes. Section 14 (2) and (3) of the Sexua Offences Act makes cear that a person does not commit the offence of arranging or faciitating commission of a chid sex offence if s/he acts to: a) Protect the chid from sexuay transmitted infection; b) protect the physica safety of the chid; c) prevent the chid from becoming pregnant; or d) promote the chid s emotiona we-being by the giving of advice provided this is not done for the purpose of obtaining sexua gratification or for the purpose of causing or encouraging the sexua activity. This exception covers not ony heath professionas but anyone who acts to protect a chid, incuding socia care practitioners. It appies to supporting young 18

20 Section 1: The roe of a socia care practitioners peope under 16. Under the Sexua Offences Act, young peope under 16 sti have the right to confidentia advice on contraception, condoms, pregnancy and abortion. Q.16 Under the Sexua Offences Act, aren t young peope going to be prosecuted for sexua activity, incuding kissing? No. The aim of the Sexua Offences Act is to make it easier to prosecute peope who pressure or force others into having sex they don t want. The aw is not intended to prosecute mutuay agreed sexua activity incuding kissing between two young peope of a simiar age, regardess of their sexua orientation, provided there is no evidence of abuse or expoitation. The foowing statement has been written to expain the Sexua Offences Act to young peope. It has been deveoped by young peope and agreed by the Home Office. Sexua Offences Act (2003): In Engand and Waes, the aw on Sexua Offences has been updated. Under this aw, the ega age for young peope to consent to have sex is sti 16, whether you are straight, gay or bisexua. The aim of the aw is to protect the safety and rights of young peope and make it easier to prosecute peope who pressure or force others into having sex they don t want. Forcing someone to have sex is a crime. Athough the age of consent remains at 16, it is not intended that the aw shoud be used to prosecute mutuay agreed teenage sexua activity between two young peope of a simiar age, uness it invoves abuse or expoitation. Under the Sexua Offences Act you sti have the right to confidentia advice on contraception, condoms, pregnancy and abortion, even if you are under 16. But remember, whatever your age, you shoudn t have sex unti you fee ready. For more information about sex and reationships visit 19

21 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas CONFIDENTIALITY Q.17 Can socia care practitioners keep information and requests about sexua heath and contraceptive advice confidentia? Yes. Young peope in pubic care have the same entitement to confidentiaity as other young peope when discussing sex and reationships issues, incuding contraception. Research makes it cear that concerns about confidentiaity stop young peope from seeking sexua heath advice 2. If socia care practitioners are going to pay an active roe in heping young peope avoid unpanned pregnancy and STIs, confidentiaity must be maintained whenever possibe. Q.18 Are there any exceptions to this? Yes. Socia care practitioners are acting within the Chidren Act to safeguard and promote the heath and wefare of the young person. They therefore have to use their professiona judgement to baance the young person s right to confidentiaity with the need to ensure their safety. If they have reason to think that the young person is being abused or expoited and/or is at risk of suffering significant harm which an intervention may prevent, they shoud encourage them to aow the reevant information to be passed on. If they refuse and the socia care practitioner beieves the invovement of others, incuding the poice, is essentia for the young person s best interests, they may discose information without the young person s consent if absoutey necessary. Maintaining the right baance between providing confidentiaity and safeguarding young peope is a compex and sensitive area of work, requiring cear poicies for practitioners. These shoud be deveoped with the Area Chid Protection Committee (or future oca Safeguarding Chidren Boards), their empoyer and/or the responsibe CSSR. These poicies shoud refect the need to judge each case individuay and incude: arrangements for initia discussions about worrying discosures with a senior coeague or designated member of the ACPC or Safeguarding Board without naming the young person concerned; a cear protoco for sharing information on a stricty need to know basis, governed by the principe of promoting and safeguarding the young person s heath and wefare; a requirement to inform the young person about what information wi be given, to whom, and for what purpose and where and how it wi be recorded 20

22 Section 1: The roe of a socia care practitioners arrangements for providing the young person with appropriate counseing and support, both during and after any Section 47 enquiry and/or poice investigation takes pace. Poicies and protocos shoud foow the Government s inter-agency guidance, Working Together to Safeguard Chidren 5. Authorities who have Heathy Care Partnerships shoud incude this work within Partnership action pans. Q.19 Working Together states that any crimina activity shoud be reported to the poice. Does this mean that a discosures of under age sexua activity shoud be passed on to the poice? Athough the age of consent remains at 16, it is not intended that the aw shoud be used to prosecute mutuay agreed teenage sexua activity between two young peope of a simiar age, uness it invoves abuse or expoitation. However, the younger the person, the greater the concern about abuse or expoitation. It is therefore expected that oca poicies and protocos wi refect the need for socia care practitioners to use their discretion in weighing up the circumstances of each individua case to determine whether a forma notification to the poice is necessary. Poicies which require automatic forma notification to the poice may stop young peope confiding in socia care practitioners, incuding those most at risk of abuse. It is important to recognise that the poice may hod information about individuas who pose a danger to young peope, which is not necessariy known to other agencies. Poicies and protocos shoud therefore incude arrangements for informa, anonymous discussion with the poice about cases of concern, to inform a decision about making a forma referra. These principes are refected in recommendations made by Sir Michae Bichard in the report of his Inquiry, pubished in June This incudes a recommendation (13) that nationa guidance is produced to inform the decision as to whether or not to notify the poice. This wi be incuded in guidance under the Chidren Bi, to be pubished by Apri 2006, which wi aso incorporate revisions to Working Together to Safeguard Chidren. During the preparation of this guidance, stakehoders wi be consuted both formay and informay. This process is ikey to start in autumn Poicies and protocos to safeguard young peope shoud be deveoped across agencies and impemented through muti-discipinary as we as singe discipine training. Exampes of oca CSSR poicies/protocos and training programmes which refect these principes can be found on 21

23 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Q.20 Do socia care practitioners have to record information about supporting young peope to access contraception or sexua heath services? Looked after chidren are entited to confidentiaity in reation to persona heath detais. It is good practice to record information that is reevant to the young person with regards to heath and webeing but this shoud be shared on a stricty need to know basis. For some socia care practitioners such as socia workers, there wi be forma ega and oca guidance about the recording of information about chidren and young peope for whom the agency is responsibe. This guidance must be adhered to. The Nationa Minimum Standards for Fostering Services (Care Standards Act 2000) 21 require that foster carers use their judgement to assess what information they keep and what shoud be passed on to the fostering service. Foster carers wi need to refer to oca poicy and work within those guideines. Some oca authorities have encouraged young peope to keep their own heath record a number of such passports or heath faxes are in use. The foster carer and young person can agree what shoud be recorded if appropriate, but the young person remains the owner of the information. SUPPORTING PARENTS Q.21 How can socia care practitioners work to support parents/carers in addressing sex and reationships issues with their chidren /chidren in their care? Research suggests that young peope who grow up in famiies where sex and reationships are discussed openy and without embarrassment, deay first sex and are more ikey to use contraception when they become sexuay active. Young peope cite parents as their preferred source of support about sex and reationships, but around haf say they have received itte or no information whie parents report being deterred by embarrassment and ack of knowedge. These communication probems are ikey to be further exacerbated if the reationship between them is aready causing probems. Socia care practitioners in contact with parents shoud discuss with them the benefits of taking to their chidren about sex and reationships. If they fee that the teenager is sexuay active or about to become so, parents shoud be encouraged to inform the young person of oca confidentia services to hep ensure the eary uptake of contraceptive and sexua heath advice. The parents of a ooked after chid or young person may express wishes about the sex and reationships or contraceptive advice they want provided. Whist every effort shoud be made to respect these wishes, the overriding principe for the socia care practitioner is to safeguard the heath and wefare of the young peope in their care. 22

24 Section 1: The roe of a socia care practitioners For exampe, if a young person discoses that they have had unprotected sex, the parents views shoud not be a barrier to immediate referra to a heath professiona for a discussion about emergency contraception. Consent to any treatment rests with the young person, provided the heath professiona considers them competent to understand the advice and treatment. Q.22 Are there other sources of support for parents/carers? Supporting parents/carers in taking to their chidren/chidren in their care about sex and reationships is an important aspect of the Teenage Pregnancy Strategy 2. Nationay, the vountary organisation Parentine Pus runs the Time to Tak media initiative, encouraging open discussion, backed by a free hepine and website to which socia care practitioners can refer parents/carers who want further advice. Locay, a teenage pregnancy strategies are deveoping ways of supporting parents/carers, through schoos, community groups and vountary organisations. Socia care practitioners are advised to contact the oca teenage pregnancy coordinator for information about reevant services, sex and reationships programmes or materias for parents/carers. Q.23 How can socia care practitioners work with the oca community to support young peope on these issues? Parenta avaiabiity and the provision of youth focused activities can both pay a roe in heping young peope avoid unwanted sex and resist peer pressure before they are ready to make their own informed choice. Where appropriate, socia care practitioners shoud contribute to oca regeneration panning to hep deveop projects where adut roe modes and youth deveopment programmes can increase the community support for young peope. Sexua heath and the prevention of unpanned pregnancies shoud be viewed within the context of wider heathy care issues. 23

25 SECTION TWO The roe of heath professionas in providing contraception and sexua heath advice and treatment For the purpose of this guidance the term heath professiona refers to doctors, pharmacists and nurses, incuding ooked after chidren nurses, contraceptive/sexua heath nurses, practice nurses, heath visitors and midwives. Sources of contraception and sexua heath advice Q.1 Where can young peope access free contraceptive advice and treatment? Young peope, incuding under 16s, can get free contraceptive advice and treatment from the foowing services. A these services are open to young women and young men, but some may have separate sessions specificay aimed at boys and young men. NHS contraceptive/famiy panning cinics; Brook and other young peope s contraceptive/sexua heath centres; Their own GP, athough most GPs do not suppy condoms; Another GP by registering as a temporary resident; Some NHS Wak in Centres; Some Young Peope s Information/ One Stop Shops/Connexions Centres; Some genito-urinary medicine (GUM)/sexuay transmitted infection cinics; Some pharmacists providing free emergency contraception under NHS arrangements, using Patient Group Directions; and Young peope aged 16 or over can aso buy emergency contraception direct from pharmacists. 24

26 Section 2: The roe of heath professionas Q.2 Where can teenagers get advice or treatment for sexuay transmitted infections (STIs)? Young peope shoud receive information and advice about sexuay transmitted infections from the contraceptive services isted in Q.1. Some may offer a imited infection diagnosis and treatment service, but most wi refer young peope to a GUM cinic, usuay based in the nearest arge hospita. GUM services shoud be incuded in the oca teenage pregnancy strategy s service checkist. Detais of cinics are aso avaiabe from the foowing websites: The provision of contraception and sexua heath advice to under 16s Q.3 Can heath professionas give contraceptive advice and treatment, to young peope under 16 without parenta consent? Heath professionas shoud aways discuss the benefits of the young person informing their parents, carers, socia worker or another trusted adut, but the heath professiona can provide contraception, sexua and reproductive heath advice and treatment for under 16s if they are satisfied that: the young person understands the advice provided and its impications; and the young person s physica or menta heath woud otherwise be ikey to suffer and so provision of advice or treatment is in their best interest. When providing contraceptive/sexua heath advice or treatment, heath professionas shoud hep the young person make an informed choice by discussing the foowing issues: the emotiona and physica impications of sexua activity, incuding the risks of pregnancy and sexuay transmitted infections; whether the reationship is consensua in nature and whether there may be coercion or abuse; the benefits of informing their GP and the case for discussion with a parent or carer. Any refusa shoud be respected; and any additiona counseing or support needs the young person may have. 25

27 Lega and Poicy Framework for Socia Workers, Foster Carers and other Socia Care Professionas Additionay, it is considered good practice for doctors and other heath professionas to foow the criteria outined by Lords Fraser in 1985, in the House of Lords ruing in the case of Victoria Giick v West Norfok and Wisbech Heath Authority and Department of Heath and Socia Security. These are commony known as the Fraser Guideines: the young person understands the heath professiona s advice; the heath professiona cannot persuade the young person to inform his or her; parents or aow the doctor to inform the parents that he or she is seeking contraceptive advice; the young person is very ikey to begin or continue having intercourse with or without contraceptive treatment; uness he or she receives contraceptive advice or treatment, the young person s physica or menta heath or both are ikey to suffer; the young person s best interests require the heath professiona to give contraceptive advice, treatment or both without parenta consent. Q.4 Can young peope under 16 buy condoms? Yes. The aw does not prevent under 16s from buying condoms from pharmacists, shops or vending machines. Nor does it restrict the seer. Confidentiaity and contraception and sexua heath advice to under 16s Q.5 Do young peope under 16 have the same right to confidentiaity as oder peope? Yes. Heath professionas have the same duty of confidentiaity to under 16s as they owe to oder patients. This is enshrined in their professiona codes. The exception to this duty of confidentiaity is outined in Q.7 beow. Q.6 If the young person is not considered competent to consent to treatment, shoud the consutation remain confidentia? Yes, except in the situations outined in Q.7 beow. Q.7 Are there any situations when heath professionas may break confidentiaity? Yes. The duty of confidentiaity is not absoute. Where a heath professiona beieves that there is a risk to the heath, safety or wefare of a young person or others, which is so serious as to outweigh the young person s right to privacy, they shoud foow ocay agreed chid protection protocos, as outined in Working Together to Safeguard Chidren 5. 26

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