CDAT & Sexual Health Pamela Jones & Alison Collins Clinical Nurse Specialists Integrated Contraception and Sexual Health Services

Strategic context  NICE, 2007 = targeting key groups at risk of STIs including those that undertake behaviours that increase the risk  National Treatment Agency for Substance Misuse (2007) = substance misuse services ensure sexual health assessment & access to safer sex advice enabled for service users with strong links to local SHS.  One Wales & Designed for Life for Wales (WAG 2007 & 2005) = increasing community based service provision

The project 1 st in Wales to identify a regular, designated, specialist sexual health resource to work with CDAT Funded by The Queen’s Nursing Institute for 1 year Aim: reduce inequalities in access to sexual health services & increase uptake of sexual healthcare for clients who access substance misuse services Objective: Every client has the opportunity to receive a sexual health assessment, advice, testing, treatment &/or referral as required.

Specific aim 1: increase opportunistic advice, screening, treatment and referral on sexual health issues for people attending substance misuse clinic. Specific aim 2: improve access to cervical cytology screening. Specific aim 3: raise awareness of potential risks in relation to sexual health in this client group. Specific Aims

Provide a drop in nurse led clinic once a week within existing CDAT services Set up a one stop shop approach to sexual health provision Develop and support a multiagency approach to service provision Identify & support clients who need onward referral to specialist services Objectives

Implementation CNS working alongside CDAT during clinic sessions offering specific sexual health interventions not normally available in this setting Sessions to run alongside CDAT clinics providing an appointment and walk in service for service users. A small steering group made up of key stakeholders will oversee the project to ensure it is on target to meet its objectives.

Merthyr Tydfilx1 per month Church Village (Nr. Pontypridd)x1 per month Rhondda Valleyx1 per month Aberdarex1 per month Venues

following detailed sexual health assessment:  health promotion & harm minimisation messages  STI testing  provision of barrier and other methods of contraception  contact tracing  cervical cytology  referral to specialist services if indicated. Service provision

Possible benefits improving accessibility & availability = individual & public health improvement with positive impact on the wider community. speedier access = timely advice, contraception and/or treatment reducing the levels of sexually transmitted infection and unplanned pregnancy. greater choice & control for clients in managing their sexual health identify wider health issues for clients and their partners/families improve their health and wellbeing in generic terms as well as gaining access to other services as indicated. developed in partnership between sexual health and community drug and alcohol services = the value of joint working & learning

Sessions commenced June Church Village + Rhondda July Merthyr + Aberdare Sessions Held to End August 2008 Aberdare2 Merthyr2 Church Village2 Rhondda2 Total sessions possible14 Total sessions held8 Project Statistics

Aberdare 2 Merthyr3 Church Village0 Rhondda2 Attendances to Date

Complex needs of client group Reluctance of clients accessing service High DNA rate Communication between staff sets Cover for annual Leave/sickness Contacting clients with positive results Providing appropriate chaperones Project Challenges

Limited availability of service provision in each area (1 per Month) Sustainability Project Challenges

Leaflets and posters in CDAT clinics Outreach workers Mainstream services Advertising project

Female Aged 22 1 Child Methadone programme Attended for Opportunistic STI screening Also had opportunistic cervical cytology Results 1.Positive chlamydia Attended mainstream services for treatment 2.Abnormal cytology Referred to colposcopy with support-DNA Staff in contact to arrange supported appointed Case Study 1

Male aged 30 Methadone programme Attended for information and advice Refused screening via swab but accepted urine for Chlamydia Results 1.Positive chlamydia 2.Attended mainstream service for treatment with partner 3.Both treated 4.Advised of need for full screening Case Study 2

Conclusion Slow to start Identifies the complexity of client cases Client satisfaction/results Evidence of integrated team working Some improved communication needed Need to address Annual leave/sickness Respond to changes in demand as the project becomes established to meet need most appropriately

Thank You Any Questions?