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Sexual health services for youth in the community during lockdown

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When all schools and clinics were closed during the lockdown, a team of school nurses stepped in to help young people access sexual health services. This initiative won the Nursing in the Community category at the 2021 Nursing Times Awards

Summary

A team of school nurses ensured that access to sexual health services remained available for young people during the Covid-19 closures when schools and clinics closed. The team found creative, innovative and new ways to deliver the service by organizing telephone assessments and establishing meeting points in various locations.

Quote: Crouch V, Donovan M (2022) Sexual health benefit for community youth during lockdown. Nursing schedules [online]; 118:10.

Authors: Viv Crouch is head nurse for Clinic-in-a-Box; Maria Donovan is a school nurse and community public health nurse specialist; both at HCRG Care Group Bath and North East Somerset. At the time of this initiative, both were part of Virgin Care’s school nursing team.

Introduction

In early March 2020, as schools and regular sexual health services were closed, young people struggled to access emergency contraception as well as any ongoing contraceptive treatment. Our team of nurses at Virgin Care were alerted to the issue through their health services by text and chat and discovered that the youngsters were in desperate need of emergency contraception and counselling. Our group had already implemented a Clinic-in-a-Box service in many secondary schools; This is an informal, free-access, mobile contraception and sexual health clinic provided in Bath and North East Somerset in school and non-school community settings, for individuals or groups.

The Clinic-in-a-Box program has operated in many secondary schools in Bath and North East Somerset over the past 15 years. Due to the pressures of the Covid-19 pandemic, we have changed the system to ensure lockdown restrictions were adhered to and young people could still receive care and support. The mobile project started at the end of March 2020 and continued throughout the pandemic; this was particularly relevant when schools had to be closed.

Clinic-in-a-Box concisely describes what we do: the device, the technology, the drugs and the material are transported in a container. Nursing staff:

  • Conduct visits to parking lots and hospital grounds;
  • Conduct a telephone assessment;
  • Give advice to young people in the neighborhood;
  • Provide contraception.

Service request

As a team of school nurses, we recognized that young people were still sexually active despite the confinement. However, access to sexual health services was extremely limited. School clinics were closed and some pharmacies were unable to offer emergency contraception after face-to-face consultation due to pandemic social distancing restrictions. As a result, many young people could not access the help they needed, so several of our sexual health nurses worked on the Clinic-in-a-Box project to meet those needs.

Our team knew that with a concerted effort, we could provide safe, accessible and confidential service. Much of our school nursing team was redeployed during the first lockdown, so with our depleted workforce a high priority was finding a way to deliver a service that met the needs of a vulnerable group. We were very aware that young people with unmet sexual health needs can easily develop increased anxiety, which can impact their mental and physical health.

the project’s objectives

Our main focus was to support young people with their sexual health needs during this difficult time, as there were no other sexual health services available to them. Our other objectives were to:

  • Effectively manage teenage pregnancies through pregnancy testing and offer treatment if needed;
  • Minimize the risk of sexually transmitted infections;
  • Sustain reduced conception rates for people under 18 by improving their access to contraception or hormonal emergency contraception;
  • Maintain communication with young people, so they know we are always available and can meet their needs.

Implementation and Collaboration

Communication was an important aspect of our project. We sent messages to young people who were already part of our workload via SMS. We also sent posters to pharmacies advertising our health chat service (a telephone service), which provided potential callers with our contact details. Some of our team members who were redeployed to the community still went the “extra mile” and responded to youth requests for help with their workload, arranging to meet them in a safe place or to refer them directly to a colleague.

From the start of the March 2020 lockdown, we began discussing ways to reach the young people in our workload. Those we have regular contact with know they can text their nurse if they need help, but we were concerned that pupils would not know what to do as schools were closed. It soon became clear – through the number of phone calls from young people unable to obtain emergency contraception – that young people were in trouble.

Virgin Care management supported our initiative. They encouraged us to meet young people in unconventional places, and the public health team in Bath and North East Somerset Council were aware of our need to think outside the box if we were to keep young people safe. We had to change the way we work to respond, especially to emergencies.

We wanted to be flexible in terms of location, time and travel so that we could reach as many young people in need as possible. Our team covered the whole of Bath and North East Somerset and we sometimes held clinics at youth clubs. Therefore, we worked closely with youth workers who still had contact with some young people. Thus, if a young person asked for emergency contraception, the worker contacted us. The help of the youth club facilitators was also essential in facilitating the accompaniment of the young people and helping us to find suitable places where we could meet, such as the car parks of the youth centers, coach parks, schools and hospital grounds.

“This passionate and enthusiastic team took care of their customers wherever and whenever needed; the effectiveness of this service demonstrates the importance of relationships, in all their forms”
(Judges’ Comments)

Challenges

The biggest challenges our team faced were around privacy. Meeting young people in public spaces or in their homes to give them contraceptives or pregnancy tests posed significant challenges. Our team has been operating throughout the pandemic, which has increased social distancing challenges for our school nurses and young people in need of assistance. We knew the challenges they faced of not being able to meet their peer group, and their feelings of isolation, worry and panic would only be exacerbated with insufficient support for their physical and mental health.

Achievements

Our recognition of important health issues for young people and the hard work to find a solution in unusual circumstances caught the attention of Bruce Laurence, who was then Director of Public Health at Bath and North East Somerset Council. When he heard about the length one of our colleagues had gone to, he wrote to us the following:

Paul Sheehan (curator) told me about your adventure “a bit more” in providing a desperate young woman with emergency hormonal contraception yesterday. An intervention that could have really changed your life. It’s so nice to hear things like that. I can’t say it’s surprising, because I know you and your colleagues often make stops to help people who need it most, but it’s very rewarding and I wanted to thank you.

Another response came from a sixth grader:

Just wanted to say thank you so much for your help today! It was amazing, very efficient and good service – I feel much, much better now, so thank you! 🙂

Our biggest achievement has been being able to go the extra mile to help young people feel safe and heard. As a team, we were more than happy to work outside the box to keep the youngsters safe and we were delighted that the youngsters trusted us enough to ask for help.

Future plans

We would like:

  • Building on the privileged relationship we have established with young people;
  • Be more flexible in our meeting places;
  • Encourage schools to be more open and responsive to sexual health.

Our desire is for schools to understand that when young people worry about their sexual health, it can also have consequences for their mental health and education.

Despite the difficulties of the Covid-19 pandemic, the students being in bubbles at the start of the school year, we managed to take stock via Microsoft Teams to advise young people and we managed to deliver contraception. It was a memorable journey, worth sharing with other practitioners, so we would like to take opportunities to share our project with a wider audience to encourage similar attitudes towards the sexual health needs of young people.

Key points

  • A sexual health service for young people during lockdown eased pressure on primary care staff, who were focused on Covid-19
  • Work to reduce teenage pregnancies continued at a time when many services were disrupted
  • A digital sexual health service has been sustainably integrated into the team’s service delivery
  • Young people’s anxiety was reduced knowing that the nursing team was easy to reach and quick to respond
  • An established care and support delivery program has been adapted to meet lockdown restrictions

Tips for a similar project

  • Make sure you have a management team on board with you
  • Understand the challenges that the communication team can raise
  • Establish a good relationship with other agencies
  • Ensure the support and enthusiasm of the whole team
  • Think outside the box to be innovative and flexible