Creating a Healthy Respect for Sexual Health March 2009 Rachael Yates and Niki Powers

Content of seminar Context – SH data, policy Approaches Education Information Services Role of social work in sexual health

Evidence The sexual health of young people in Scotland is poor High teenage pregnancy rate Sexually transmitted infections rising Worse in areas of deprivation Unwanted sex and regret Links with alcohol SRE does not increase sexual activity

Evidence – Vulnerable YP early sexual risk = experiencing sexual intercourse early, coercion, non-use of condoms, STIs and regret. Predictors of increased sexual risk: –Vulnerability in terms of deprivation, –living with a single biological parent, –low levels of parental monitoring –living in a care or foster home.

Evidence – Vulnerable YP Deprivation associated with higher rates of conceptions deprived young women were –more likely to go on and become a teenage mothers, –less likely to have terminations than their more affluent counterparts Young people from deprived families are more likely to be suspended or excluded from school Low educational attainment among boys and girls, truancy and school exclusion are strongly associated with teenage pregnancy.

Evidence – some studies 1/4 of young women leaving care had a child by 16 and nearly half were mothers within months of leaving care. (NCB 1995) of 50 girls excluded from school 14% became pregnant during their period of exclusion. (Social Exclusion Unit 1999)

Pause for thought Why is the sexual health worse in areas of deprivation / single parent families / low parental monitoring / foster care and residential care?

Influence of parents Attachment –Intersubjectivity, –Communication, –Sense of emergent self, –Relationships, –Motivation, –Resilience.

Disrupted Attachment: Long-term affect Trust, Communication/interaction, Learning, Eating, Drugs/alcohol, Challenging behaviour, Self-esteem, Self control and emotion management, Mental, physical, social and sexual health.

Attachment Reading Bowlby, J. (1969) Attachment and Loss: Vol 1, Attachment. New York, Basic Books. Trevarthen, C. (1979) Communication and Cooperation in Early Infancy: A description of Primary Intersubjectivity. In M.M. Bullowa (Ed), Before Speech: the Beginning of Interpersonal Communication. New York, Cambridge University Press. Stern, D. (1985) The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. New York, Basic Books.

Top 10 reasons for having sex With people near you, compile the top 10 reasons people have for having sex….

Cognitive Behavioural Cycle How I FEEL about myself How I BEHAVE – what I DO How I THINK about myself How OTHERS see me

Cognitive Behavioural Cycle Negative or positive cycle, Recognising emotions (bodily experience, thoughts, resulting behaviours), Strategies for expressing emotions in different ways, Strategies for managing difficult emotions.

Policy context Respect and Responsibility QIS Standards for Sexual Health Curriculum for Excellence

Healthy Respect Through partnership, we aim to create an environment that will lead to long-term improvements in the sexual health and well-being of young people.

Respect Responsibility Inclusiveness Partnership

A Shared Approach Making the links between education and health information accessible services educationtarget group

What can you remember about your SRE? Sexual Health and Relationships

Holistic model of sexuality l

Case Study – education Health Opportunities Team Example of front line work with Vulnerable young person excluded from school / area of deprivation Purpose: to widen out the idea that education has to happen in schools, needs to be done by a teacher or expert.

Education with vulnerable young people in a non-school setting ‘Looking After Me’ – 6 week programme for young people in partnership with staff in Secure Unit, -Emotional well-being and emotional literacy, -Drama, film and art, - Strategies for coping.

Case Study Group of young people (aged between 13 and 15), mixed gender, range of issues, in Secure Unit. What did young people say: “Aye. I’m thinking before I do things. It helped me to get on with everyone else better”. “Aye, I’ve learnt about being assertive”.

Communication tools to influence culture Website PR and media relations Events and network activities Print resources and distribution Media campaigns

What we did: high profile

Increasing Access to Services For Young People Network of 22 local drop-ins providing a range of low threshold services Generic Health & Sexual Health Partnership approach Different models of drop-ins: schools, health or community settings All services meet all I want-LIVE standards

Exercise on talking about sex Think about the last time you had sex. Turn to the person next to you and tell them about it.

Delivering a service to a vulnerable young person ‘Turn Around’ – 8 week programme of 1-1 support, ‘Overcoming Trauma’ – ongoing 1-1 support, - Setting to suit young person, - Therapeutic, - Strategies for coping or for changing behaviour.

Case Study Young woman (aged 17): Early childhood: experienced domestic violence and rape before age of 8, mother an alcoholic, neglect, in care since age 13. Now: finds herself regularly coerced into having sex, drinks alcohol or takes drugs to help her cope. Experiencing depression and anxiety. Difficulty with eating and feelings of self-hatred. Sabotages efforts to help her. What she said: “It’s helped me. It’s good to know a bit more about why I feel like this and why I do some of the things. Makes me feel more normal. I’ve been practicing saying no – for wee things and it’s worked quite good. I feel a bit less pressure since I’ve someone to talk to”.

Role of Social Worker in SRE What can social workers do to contribute to improving the sexual health of vulnerable young people? (spend 2 minutes alone thinking about this, then pair up with someone to discuss) Think Education / Information / Services Think about addressing all petals on the ‘flower’ diagram.