Sexual health and relationships: What are the experiences and the needs of Scotland’s most vulnerable children and young

1. Sexual health and relationships: What are the experiences and the needs of Scotland’s most vulnerable children and young people?

2. What’s state of the art sex education in mainstream schools achieving? • SHARE: teacher-delivered sex ed • Longitudinal RCT in Scotland (N~8,000) Representative of young people 14-20yrs SOME POSITIVE OUTCOMES Knowledge Attitudes Quality of relationships Less regret of sex BUT NO DIFFERENCE Rates of sexual experience Contraceptive use Conceptions (NHS linked data) Terminations (NHS linked data)

3. Defining sexual risk? • experiencing sexual intercourse at an earlier age • coercion • non-use of condoms • STIs • regret

4. Earlier sex a risk? • Younger sex is associated with: • poor quality and non-consensual nature of much early sexual activity, particularly for girls • not practising contraceptive use • thus exposure to conceptions and STIs • higher levels of regret

5. Regret of sexual intercourse -comparing those who experienced 1st intercourse at different ages (%)

6. What does influence early sexual debut? • not living with both biological parents • Living in a care or foster home • mother aged less than 40 yrs • manual (blue collar) parental social class • lack of religious belief • limited educational or career aspirations • low parental monitoring • high spending money • friends’ smoking (peer influence) • neighbourhood deprivation

7. What does influence non-use of condoms? • not talking about contraception before intercourse • not planning to have intercourse • pressure to have sex • relationship less than 1 month duration • friends’ non-use of condoms • negative intentions, attitudes, norms and lack of anticipated regret

8. Trying to improve ‘respect’ and social skills • An RCT of Zero Tolerance Respect taught in Primary 6/7 • Increased ‘respect’ among boys at an age it was decreasing among the comparison group • No significant difference for girls

9. Sexual risk factors and exclusion from school • Most of these risk factors are also associated with exclusion from school (Raffaele Mendez 2003) • Suspension increases social exclusion and engagement in subsequent anti-social and risky behaviour (Hemphill 1996)

10. Vicious circle… • disrupted family life • poor educational access and attainment • lack of information and support around sexual health relationships (not at school to get sex education or sex education disrupted) • having practical and psychological barriers to accessing sexual health and contraceptive services • All of the above are associated with the likelihood of experiencing a teenage pregnancy!

11. How schools with different pupil compositions\risk factors look in terms of conceptions and terminations at age 16 - NHS recorded objective data

12. How schools with different pupil compositions\risk factors look in terms of sexual experience reported at age 16

13. Research messages • Teenage pregnancy only likely to be influenced by broader social initiatives • tackling social exclusion • neighbourhood cultures and resources • raising aspirations • most promising programmes v. long term, broader than SRE and change future life opportunities • SRE might improve emotional wellbeing • challenge is to deliver targeted programmes at right time

14. From SHARE to where? Future research plans… • SHARE: teacher-delivered sex ed • Longitudinal RCT in Scotland (N~8,000) Representative of young people 14-20yrs SOME POSITIVE OUTCOMES Knowledge Attitudes Quality of relationships Less regret of sex BUT NO DIFFERENCE Rates of sexual experience Contraceptive use Conceptions (NHS linked data) Terminations (NHS linked data) Vulnerable young people School ethos Media influence Multi-component interventions Social marketing Parents Enhanced SHARE Community based youth friendly services Interventions with parents Neighbourhood culture

15. Young people through care system More likely to leave school early 1 in 4 have a child by age 16 Half of female care leavers are mothers within 24 months of leaving care 38% of female prostitutes had experienced care 60% of male prostitutes had experienced care Young people not experienced care system Leave school later 1 in 10 gives birth to at least one child by age 20 1 in 5 experience at least one teenage conception by age 20 1 in 10 terminate at least one conception by age 20 Examples of outcomes for most vulnerable (LAYP) vs average young people

16. What is SRE? Curriculum for Excellence: Health & Wellbeing Outcomes • make informed decisions in order to improve their mental, emotional, social and physical wellbeing • experience challenge and enjoyment • experience positive aspects of healthy living and activity for themselves • apply their mental, emotional, social and physical skills to pursue a healthy lifestyle • make a successful move to the next stage of education or work • establish a pattern of health and wellbeing which will be sustained into adult life, and which will help to promote the health and wellbeing of the next generation of Scottish children.

17. What is SRE? Personal & Social Education Sex & Relationships Education Secondary School Health Education Catholic Secondary School Relationships & Moral Education Religious Education Alternative Education Life Skills

18. Rights & Responsibilities • UN CRC • WHO • European CHR • Scottish Government • LTS (Learning Teaching) • NHS • Local Authority

19. Age & Stage End of Nursery End of Primary P7 End of Secondary S4 • Making friends • Healthy bodies • Keeping safe • Physical – babies, body parts, puberty • Emotional – feelings, emotions, friendships • Social – gender roles, media, independence • Knowledge – STIs, pregnancy, services • Values – rights, responsibilities, equality • Skills – negotiation, condom use,

20. Possible Issues for Young People in Alternative Education Settings

21. Possible Issues for Staff in Alternative Education Settings

22. Aggressive Sensitivity Embarrassed Attention problems Wide range of functioning Literacy problems Anti-authority Shy Motivation Too difficult Doesn’t want to participate Upset Challenges for alternative education settings

23. Solutions/suggestions? • Literacy problems - minimise need for pupils’ reading • Attention – lots of 5-10 minute sessions • Shy – be reassuring • Upset – be reassuring and have support options available before starting a session • Aggressive – be patient • Embarrassed – don’t be embarrassed yourself • Motivation – bring in creativity to the exercises, perhaps also quizzes, games and drama • Wide range of functioning – make a pack that teachers who know their pupils can adapt appropriately

24. Solutions/suggestions? • Sensitivity – be aware of it and have support options available before starting a session • Anti-authority – interactive and respectful teaching methods, not didactic • Doesn’t want to participate – try to motivate, perhaps best to respect the pupils wishes? • Too difficult – reassure, patience and assess whether it is appropriate for this pupil

25. SRE Programmes for Alternative Education Settings Cross age & stage Cover absolute basics Recovery as a journey not a destination Aim to reduce harm Individually tailored Interactive & fun Drugs & alcohol On-going not one-off Anti-homophobic

26. Feedback from young people based in an alternative education (AES) setting The young people would like: • nearby and friendly sexual health services • staff from these services to meet them in their AES setting (think it’d make them more likely to visit them afterwards) • to be respected by adults teaching them and talking to them • to be listened to by adults teaching them and talking ‘with’ them • fun and participative lessons

27. An Example • Think . . . • Feel . . . • Do . . .