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Improving healthcare for young people

Mary Jackson
SRN
Lead Nurse
Young People's Information Centre
Harlow PCT
E:mary.jackson@harlow-pct.nhs.uk

Sarah Doran
MSc
Health Development Adviser
Harlow PCT
Essex
E:sarah.doran@harlow-pct.nhs.uk

Mary Jackson has been working fulltime as the lead nurse at the Young People's Information Centre (YPIC) in Harlow, Essex, for the past two-and-a-half years. Consultations with young people, innovative ideas from directors of health, and funding from the Harlow walk-in centre (WIC) have allowed this project for young people to be set up and developed. Mary finds her post most rewarding: "Just seeing the relief on young people's faces when help is obtained in various matters of health is extremely satisfying. We are able to lessen the inequalities to health by frequently acting as advocates and breaking down the barriers on their behalf."

The number of young people accessing the health service at the YPIC has increased from 20 a month in 2000 to 342 in October 2002. There has also been a change in contraceptive uptake. In 2001, twice as many young people came to the service to get emergency contraception as came to get the contraceptive pill. In 2002 these figures reversed, with twice as many young people accessing the contraceptive pill rather than emergency contraception. Since July 2002, almost 500 young people have accessed the C-Card condom scheme, which allows them easier access to condoms.

History of the service
The 1996 census showed that there were 14,900 people under the age of 25 living in Harlow. Harlow Council has a history of being proactive in identifying and attempting to meet the needs of young people - the town's future citizens.

A needs analysis was done by holding youth conferences in 1996 and 1997. At these conferences, young people said that they saw their needs as being different from the needs of adults, that they were unsure what services existed, and that they would like better knowledge of sexual health issues. In 1998, Harlow had the highest teenage conception rate in North Essex,(1) together with high deprivation rates.(2) Harlow also had the highest number of children on the child protection register in Essex (59.9 per 10,000),(3) along with low literacy levels,(4) all linking to poor health.

After identifying the need to tackle these issues and set up a service for young people in Harlow, it was decided that a multiagency approach was essential. Partner agencies visited young people's projects that were seen as centres of excellence, such as "The Corner" in Dundee.(5) From this research the team identified the following aspects, which they felt were important to the Harlow service:

  • A centrally located venue.
  • A service that can respond to a range of issues faced by young people, from housing to health, especially sexual health.
  • A confidential service.
  • A one-stop shop.
  • Staff with nonjudgemental attitudes.
  • A welcoming environment - "someone with a smile".(6)

In the beginning …
A centrally located building was provided by the council, and the YPIC opened in 1998. A community youth development/ manager was employed by the council to coordinate partnership working.

Initially, two sessions were run at the YPIC by the family planning and sexual health nurses and one by the family planning school nurse. Harlow Primary Care Trust's (PCT) Teenage Pregnancy Health Improvement Programme (HIMP) group led them to further develop the health service at the YPIC. Support for the work came from the national and local teenage pregnancy figures, the Social Exclusion Unit report(7) and The NHS Plan,(8) which indicated the need for improving access for young people and for reducing health inequalities, and listed the Chief Nursing Officer's 10 key roles for nurses.

The initial plan was for the WIC in Harlow to provide a fulltime lead nurse for the YPIC, to coordinate all the nurse sessions. The nurse would be experienced in family planning and would deliver health education, advice and treatment. Clinical governance would be carried out through:

  • A computer-aided system (CAS) for diagnosis of general health issues, with algorithms.
  • Shared Patient Group Directions (PGDs).
  • Training in all nursing issues.
  • An experienced team of WIC nurses with which to network.
  • Support from the medical team (GPs and the Department of Sexual Health [DOSH]).

And now …
The health service at the YPIC is a drop-in service. Other agencies, such as the WIC and GP practices, may also refer young people to the YPIC services. News of the service has spread by word of mouth and advertising.

The YPIC has an informal reception area run by youth workers, who refer young people directly to the nurse/GP without taking any personal details.

Mary works there fulltime with a variety of other health professionals, including practice nurses, sexual health nurses, school nurses and WIC nurses, who are all family planning-trained. There are two weekly lunchtime medical sessions run by a female GP, who is employed by Harlow PCT. All health professionals working at the YPIC have a direct telephone link with midwives, GPs and the DOSH as required.

PGDs are used by all the nurses working at the YPIC, and there are direct referral pathways for termination of pregnancy (TOP) and emergency dating scans (EDS).

Services on offer
The health professionals working at the YPIC offer the following confidential services:

  • Treatment and advice of many general health issues, with referral when indicated.
  • Other treatments available from WIC nurse ­sessions (through PGDs).
  • Pregnancy tests.
  • Free condoms via the C-Card scheme.
  • Emergency hormonal contraception.
  • Contraceptive pill or injection.
  • Screening for chlamydia in females.
  • Cervical smears if indicated.
  • Someone to listen.

Many of the young people who come to the YPIC have emotional health problems as well as physical health problems. These young people can be referred to the registered mental health nurse, who works at the YPIC fulltime during the week, or to counsellors who provide sessions during opening hours.

Outreach sessions are delivered to allow young people to get to know and trust Mary. Health education is delivered to young people in job search groups. Mary also takes part in residentials - she even went to the Pyrenees on a Connexions trip to deliver sex education on a mountain hike!
Other sessions include education in sexual health, the dangers of smoking, healthy eating, parenting and personal hygiene, linked up with literacy links for health. Several nurses from YPIC take part in delivering the "A PAUSE" sex education project.(9)

Sessions on sexual health have been delivered in the local nightclub with the Health Development Adviser from Harlow PCT (Sarah Doran). Mary and Sarah were interviewed on stage by an Ali G lookalike to promote condom use. That was a huge success:

"I would never have had 200 young people listening intently as they did that night. The next day several young people came to me and said that they felt it was really cool and suggested that we tour the nightclubs. These tours are being planned" - Mary Jackson, 2002

Emergency dating scanning
A direct referral system was set up in August 2002 to enable EDS for young people at the local hospital (see Figure 1).

[[NIP10_fig1_42]]

Mary worked with the Head of Women's and Children's Health at the Princess Alexandra Hospital (PAH) in Essex, the Sexual Health/Teenage Pregnancy HIMP Steering Group at Harlow PCT, the lead clinician for women's health at the PAH, and the superintendent of the scanning department at the PAH, to set this system up. The referral system was established as there were several cases where young girls wanted a TOP but were unsure of their last period date and either did not want to access their own GP or were unregistered. Because of this, dates could not be established (in Harlow, TOPs are usually done by the 12th week). The direct referral system allows the young person to be scanned immediately, as time is often short. It also avoids the potential risk of them seeing people they know, which is a real concern for young people. Although this system is not needed very often, it is very important. In fact, since it has been in place, the system has been used only twice. The first time involved a 15-year-old girl, who presented with a positive pregnancy test. Her periods were irregular, and she could not remember her last date, but felt that it was at least two months previously. The second time involved a 17-year-old girl who had taken emergency hormonal contraception on several occasions, making her periods erratic. She presented with a positive pregnancy test, feeling sure that she was about 14 weeks pregnant. This meant that we were having to plan a TOP in an area outside Harlow, which brought with it more issues for the young girl. Both scans showed the pregnancies to be less than eight weeks, so TOPs could be arranged locally. The direct referral system proved to be really efficient.

Other developments
Other recent developments include:

  • Setting up the C-Card scheme in Harlow to allow young people easier access to condoms. This ­initiative has worked well in other areas of the country to prevent unwanted pregnancies and ­sexually transmitted infections.
  • Working with young people to design and produce a directory of local sexual health services for young people to use. The directory contains a map of the area (including local landmarks well known to young people, such as the Harvey Centre shops and the BP garage, as well as sexual health services).
  • A credit card-sized confidentiality card is included within the sexual health directory, to enable young people to access emergency sexual health services.
  • Networking with young people to produce an emergency hormonal contraception leaflet that they could understand.

The health service at the YPIC is monitored through the WIC CAS and through the YPIC's own monitoring data. Mary provides quarterly reports to Harlow PCT's Sexual Health/Teenage Pregnancy HIMP Steering Group. The YPIC partner organisations commissioned a research project to review the services at the YPIC. The findings of this report were presented in October 2002 and showed that "health" within the YPIC was the service used most often by young people.

"Among 17-20 year olds, the most frequently ­highlighted reason for visiting the YPIC was to receive health advice, including advice on sexual health, plus (with equal frequency) to access use of the internet facilities."(10)

The future
In 2003 the following are planned:

  • A noninvasive chlamydia screening service, ­provided by the YPIC, in conjunction with the local DOSH, as recommended in the Department of Health's National Strategy for Sexual Health and HIV.(11) This will help reduce the high rate of chlamydia in Harlow.
  • An advocacy support worker employed at the YPIC to accompany young ­people to other ­services, such as the DOSH, when needed.
  • A young men's health group at the YPIC.
  • A YPIC nurse session to be run monthly from the local college.
  • A session of the YPIC's health service, to be run by a school nurse at a satellite venue.

We also hope to hold a professional workshop to share good practice in our teenage ­pregnancy/sexual health work.

Mary puts the success of the project down to the close working partnership between young people, health professionals, youth workers and other professionals. This has allowed traditionally organisational boundaries to be overcome. The YPIC has helped to break down the barriers that prevent young people  accessing health services. This model of working differs from the traditional model - it provides healthcare in a relaxed atmosphere and in a professional way that suits young people.

"I feel that services for young people, citizens of the future, need to change to ensure that we reach them. Unless services have contact with the young people then we can't expect improvements in health in their adult lives" - Mary Jackson, 2002

Contact details
Mary Jackson
T:01279 625735

If you are ­interested in ­visiting the YPIC Centre, tours can be arranged. Please contact: Maureen Pearman
T:01279 446815

To contact the main Harlow
walk-in centre, please contact: Siobhan Jordan
T:01279 694775

References

  1. Department of Health. Compendium of clinical and health indicators. London: Department of Health; 1999.
  2. North Essex Health Authority. Annual public health report. Wiltham, Essex: NEHA; 2000.
  3. NEHA. Tackling teenage pregnancy. A local profile of teenage pregnancy and service provision in North Essex. Wiltham, Essex: NEHA; 2000.
  4. Basic Skills Agency. Consultancy report: basic skills in Harlow. London: BSA; 1998.
  5. The Corner [website]. John Hosie - Project coordinator. Available from URL: http://www.thecorner.co.uk
  6. Brook Advisory Centres. Someone with a smile would be your best bet … what young people want from sex advice services. London: Brook Advisory Centres; 1998
  7. Social Exclusion Unit. Teenage ­pregnancy. Report by the Social Exclusion Unit. London: The Stationery Office; 1999.
  8. Department of Health. The NHS Plan. A plan for investment. A plan for reform. London: The Stationery Office; 2000.
  9. Department of Child Health School of Sport and Health Sciences. Added power and understanding in sex ­education. Programme overview. Exeter: University of Exeter; 2002.
  10. Noble D, Cooper W. A review of Harlow Young People's Information Centre. Research Report. YPIC; 2002.
  11. DoH. The national strategy for sexual health and HIV ­implementation action plan. London: DoH; 2002.