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Sexual Health and Teenage Pregnancy Board Meeting – 8 April 2008 Wendy Nulty Health Promotion Specialist – Teenage Pregnancy Deborah Williams PCT Sexual Health & Risk-taking Behaviour Manager Teenage Pregnancy 2 National targets • To halve the number of under 18 conceptions by 2010 (and establish a downward trend in under 16s) • To increase the proportion of teenage mothers in education, employment and training (EET) Under 18 conception rates - 2006 • England 40.4 13.3% from baseline (1998) • North West 44.0 12.5% • Merseyside 41.0 19.1% • Wirral 47.3 6.5% (Rates are per 1000 females aged 15-17 yrs) • In 2006 there were 309 conceptions to under 18s • An additional 7 conceptions increased the rate from 45.6 in 2005 to 47.3 in 2006 • 48% of conceptions end in abortion in Wirral (England = 49%) • National Support Team What is working well… Healthy Schools • SRE enhanced status • 17 teachers currently on PSHE CPD • One of 11 LAs involved in NW SRE Guidance pilot KS3 (Yrs 7-9) School Nurse PSHE CPD • 21 out of 22 secondary schools have School Nurses with PSHE CPD qualification. For the first time Special School Nurses are now on the CPD programme with School and Community nurses. What is working well… Wirral Brook ‘All Different All Beautiful’ and ‘Bite-size’ • Independently evaluated - highlighted self reported behaviour change and increased knowledge and confidence. ADAB now accredited with OCN. National interest • 4000 young people have engaged in Bitesize “I have learnt that I am a confident person with the ability to be whatever I want” (male age 12) Health Promoting Youth Units • Fender Youth Club – Woodchurch www.Kooth.com • 1027 registered users • Counselling issues include relationships, anxiety, bullying and confidence Confidential Advice Service (CAS), Wallasey • 26% of contacts April – Dec 07 were male (total contacts 434:115) • Room 313 - CAS working in partnership with Chlamydia Services in Wirral Met Conway Park Looked After Children (LAC) • Let’s Make it Happen Training • Sexual Health Policy for LAC • All Different All Beautiful • Relationships and sexual health covered in LAC health reviews Further attention required… • Increasing under 16 rates and high proportion of subsequent pregnancies to teenage mothers • Consistency – Quality of SRE, short term funded projects, shifts in focus. • Targeted SRE work with those who miss school or who are not currently in mainstream education • Increase uptake of PSHE CPD further amongst secondary schools in areas with high conception rates • Alcohol use and young people • Mainstreaming of projects which have demonstrated positive outcomes • Workforce training Case Study: Family Planning Clinic, VCH Tuesday 1.30-3.30 pm Jan-March 07 attended by 19 girls aged 16 and under • 85% from two Wallasey schools Reasons for attendance • Pregnancy testing and abortion referral • Chlamydia testing • Combined oral contraceptives (COC) • Emergency hormonal contraception (EHC) • Advice Implications • Girls are bypassing School Nurse who can only signpost to services • Girls are missing out on their education in order to access VCH • Unsanctioned by school • Girls not accessing follow-up support - increased risk of repeat episodes • Full skill set of School Nurse Service not being utilised on-site Case Study: School Nurse Service Girl saw school nurse Monday am due to unprotected sex with boyfriend whilst drunk (early Sun am). Issues: • Girl wanted EHC (emergency contraception) immediately • School Nurse (SN) organised appointment at Brook • Girl misled Mum about needing to go to Birkenhead after school • Bus fare provided by SN • Supportive boyfriend - both anxious about being seen in school uniform • Follow-up in school the next day to ensure attendance SN emergency prescribing of EHC or a pregnancy test would have • Provided immediate care thus increasing efficacy of EHC • Greatly reduced anxiety and minimised negative impact experienced by the girls • Minimum disruption to learning • Ensured continuity of care and follow-up without having to involve another agency • Confidentiality maintained in both cases HIV & AIDS – persistent urban myths • There is a cure • Wearing a condom does not protect against sexually transmitted infections • Only immigrant and gay communities get HIV Wirral and neighbouring authorities HIV/AIDS cases: Infection Routes 2006 Wirral: • 17 new cases; 14 (82.4%) heterosexual transmission; 3 MSM (17.6%) Liverpool: • 67 new cases; 43 (64.2%) heterosexual transmission; 15 MSM (22.4%); 7 (10.4%) undetermined; 2 (3%) Mother-to-child Sefton: • 16 new cases; 9 (56.3%) heterosexual transmission; 5 (31%) MSM; 1 (6.3%) injecting drug use; 1 undetermined Chester: • 16 new cases; 8 (50%) heterosexual transmission; 7 ( 43.8%) MSM; 1 undetermined Predominant white male Improving the Contraception offer • Workforce development • Improve uptake and retention of Long-acting Reversible Contraception (LARC) as a % of all contraception on offer to under 25s • EHC+ in pharmacy development • Health Services in Schools • Room 313 Abortion / Contraception Interface – Non-Complex Cases Patient finds Termination Of she may be pregnant Pregnancy Attends GP / Brook / Family Planning or other service provider for pregnancy test, discussion and referral Self-referral Not pregnant – Contraception, Sign posting/offer of STI testing Referring organisation contacts CBS Booking line EM Provider Counselling Assessment & Scan Abortion LARC offer (implant) Prescribe and fit Help-line Patients are over 9 wks+6 days STOP Provider Counselling Treatment Discharge Patient sign-posted / offered appointment for LARC, prescribe and fit STI enhanced surveillance headlines 2006 Chlamydia; Genital Warts; Gonorrhoea; Genital Herpes; Primary and Secondary Syphilis • Highest prevalence of infection in 20-24 age group • 82% of infections diagnosed and treated locally • Chlamydia: a gateway infection, high performing service, additional investment may be needed to meet new target from DH to reach mobile ‘work hard play hard’ generation • Promote SH check as norm among target population Summary • Addressing issues as part of risk-taking behaviour agenda among 20-24 year olds • Reducing teenage conceptions top priority • Range of new health and well-being services for YP have been developed • Need for existing services to become more YP friendly Any Questions?