1. Sexual health and relationships: What are the experiences and the needs of Scotland’s most vulnerable children and young people? Dr Marion Henderson MRC Social & Public Health Sciences Unit Moray Paterson Programme Leader NHS Health Scotland

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) Interventions with parents Multi-component interventions Social marketing Parents Enhanced SHARE Community based youth friendly services Media influence School ethos Neighbourhood culture Vulnerable young people

15. Examples of outcomes for most vulnerable (LAYP) vs average young people 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

16. What is SRE? 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. Curriculum for Excellence: Health & Wellbeing Outcomes

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

18. UN CRC WHO European CHR Rights & Responsibilities 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 Knowledge – STIs, pregnancy, services Values – rights, responsibilities, equality Skills – negotiation, condom use, Physical – babies, body parts, puberty Emotional – feelings, emotions, friendships Social – gender roles, media, independence

20. Possible Issues for Young People in Alternative Education Settings

21. Possible Issues for Staff in Alternative Education Settings

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

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

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...