Safeguarding Young People: Legal Frameworks & Confidentiality in Sexual Health

1. SEX AND THE LAW WENDY MOORE CLINICAL SERVICE MANAGER / NURSE SPECIALIST – CONTRACEPTION AND SEXUAL HEALTH

2. AIM OF THE SESSION • To enable participants to develop safe working practices with under 18 year old young people

3. INTENDED LEARNING OUTCOMES • To be aware of relevant legal frameworks • To understand issues of confidentiality • To revisit child protection issues • To discuss ways of assessing and documenting competence/exploitation issues

4. WHAT’S HOT! • Sexual Offences Act (2003)¹ • The Bichard Inquiry (2004)² • The Laming Report (2003)³ • Best Practice Guidance for Doctors and Other Health Professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health (2004)4

5. AND ……… • Working Together to Safeguard Children (2006)5 • Safeguarding Children Inter-agency Procedures. Wolverhampton: WSCB (2006)6 IS IT ANY WONDER YOUNG PEOPLE ARE CONCERNED!

6. WHY DO YOUNG PEOPLE NEED CONFIDENTIAL HEALTH ADVICE • Up to 25% have sex under the age of 167 • 50% of under 16s use no contraception 7 • UK has highest TP rates in Europe 7 • STI rates in under 20s are rising 7 • The impact of TP and dangers of STI acquisition have long-term social, psychological and physical repercussions 7; therefore, • Access to free confidential sexual health advice is a key factor in improving contraceptive use and teenage sexual health 7

7. WHAT DO YOUNG PEOPLE WORRY ABOUT? • Deliberate breaches of confidentiality • Informal accidental breaches of confidentiality • Gossipy receptionists • Confidential information sent by post

8. WHAT YP BELIEVE CONFIDENTIALITY MEANS IN PRACTICE • You think they won’t tell anyone, well you hope they won’t… • They are not supposed to tell anyone…. • I thought it was only confidential if you were over 16, otherwise they would tell your parents……….. • They need your parents’ consent for the pill……….

9. REASSURING YOUNG PEOPLE • A statement on confidentiality in premises • A form they sign with the confidentiality statement on it • A specific leaflet for young people • A poster on confidentiality in communal areas • Talk about confidentiality in consultation • Inform others – teachers, youth workers etc. – that YP will be seen confidentially

10. AND THIS MEANS? • All places accessed by young people have tremendous potential to support young people and to reduce sexual health problems • Confidentiality is the key to engaging with young people • When they get ‘good service’ the grapevine gives publicity – and the reverse is true also!

11. USUALLY • All information / records generated in the course of your employment is confidential • Information must not be given to others without consent BUT CHILD PROTECTION IS DIFFERENT

12. CONSENT • All YP have a right to decide to receive treatment and information or not • Information should be accurate, truthful and presented in such a way as to make it easily understood • You must respect their right to decide

13. CHILD PROTECTION REVISITED – SEEING THE RISK A young person may be harmed • by an action - such as a physical attack, sexual abuse or exploitation, mental cruelty OR • through a failure to act – e.g. through a parent / carers neglect or through the YP not being given appropriate health care.

14. ACTION REQUIRED • All YP under 16 should be assessed for sexual abuse and exploitation; specifically ask about: • age; age of partner; maturity; drug and alcohol use; evidence of ‘grooming’; number of partners; living arrangements, attendance at school and assess for competency (using Fraser Guidelines4). • YP who appear withdrawn, fearful, inappropriately seductive, have signs of physical abuse or self-harm, refuses to discuss or minimises injuries, disclose about a ‘friend’, in care, known to Social Services or are on the register. • YP under 13 • YP who present frequently • Partner much older – and / or known to another agency • YP with learning disabilities • YP who are pregnant

15. FRASER GUIDELINES4: In order for a young person (YP) to be deemed Fraser competent the following criteria must be met: • The YP is mature enough to understand the potential risks and benefits of the advice and/or treatment given. • The YP has been encouraged to inform their parents/allow you to inform them of the YPs contraceptive needs. • The YP is likely to begin or continue having sexual intercourse with or without contraceptive advice and or treatment. • The YPs physical or mental health or both are likely to suffer unless they receive contraceptive advice and or treatment. • It is in YPs best interests to provide contraceptive advice and or treatment even without parental consent.

16. MANAGING DISCLOSURES • How can young person best be helped to protect themselves from harm? • Would outside advice be helpful? • Work towards voluntary disclosure • Does the situation warrant disclosure against YPs wishes? • What support/counselling do they need?

17. MANAGING DISCLOSURES • ACTIONS • Address all the key questions • If concerns remain – consult with others • Keep YP informed and agree a ‘safe’ way to contact

18. CHILD PROTECTION – RECORD AND ACT RECORD Your concerns and the evidence that supports them in detail SHARE This information with a manager or supervisor or named nurse for child protection (essential if <13) REFER To the appropriate person verbally and in writing FOLLOW UP The referral to make sure that something has been done

19. RECORDING – KEY PRINCIPLES • RECORD YOUR CONCERNS ASAP • BE AS FACTUAL & ACCURATE AS POSSIBLE • Begin by writing all the facts down; what you saw, what was said, physical evidence, what action you took and reason • ADD YOUR OPINIONS & INTERPRETATIONS SEPARATELY • NOTE DOWN ANY OTHER WITNESSES / COLLEAGUES with whom you shared information or who can corroborate any part of your record • RECORD YOUR REASONS FOR DISCLOSURE / NON DISCLOSURE • DATE AND SIGN THE RECORD

20. WHERE DO WE STAND? • Doctors, nurses and health professionals have a duty not to disclose any information about individual patients without consent -whatever age or maturity, except in exceptional circumstances. • Such circumstances may arise if health and safety or welfare of patient or others would be at risk of significant harm. • Whenever possible patients should be informed before confidentiality is broken unless to do so would be dangerous to them or others.

21. REVISITING THE ISSUES • What is confidentiality? • What is consent? • What age can a young person consent to medical treatment? • Contraception for under 16s? • Can confidentiality be maintained even if treatment is refused?

22. QUESTIONS? THANK YOU

23. REFERENCES • 1: Sexual Offences Act 2003, London: HMSO, 2003. http://www.opsi.gov.uk/ACTS/acts2003/20030042.htm • 2: The Bichard Inquiry. An Independent Inquiry Arising from the Soham Murders, 2004. http://www.bichardinquiry.org.uk/ • 3: The Victoria Climbié Inquiry. Report of an inquiry by Lord Laming, 2003.http://www.victoria-climbie-inquiry.org.uk/finreport/finreport.htm • 4: DH. Best Practice Guidance for Doctors and Other Health Professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health. London: DH, 2004. http://www.dh.gov.uk/assetRoot/04/08/69/14/04086914.pdf • 5: DfES. Working Together to Safeguard Children, A guide to inter-agency working to safeguard and promote the welfare of children. London: DfES (2006). http://www.everychildmatters.gov.uk/workingtogether/ • 6: WSCB. Safeguarding Children Inter-agency Procedures. Wolverhampton: WSCB(2006). • 7: Social Exclusion Unit. Teenage Pregnancy. London: DH, 1999. http://www.socialexclusionunit.gov.uk/