Sexual health provision for young people in the community during lockdown

Introduction

At the beginning of March 2020, with schools and usual sexual health services closed, young people were struggling to access emergency contraception as well as any ongoing contraception treatment. Our nursing team at Virgin Care was alerted to this problem through its text-a-nurse and chat health services and discovered that young people were in desperate need of emergency contraception and advice. Our group had already established a Clinic-in-a-Box service in many secondary schools; this is an informal, open-access, mobile contraception and sexual health clinic, delivered across Bath and North East Somerset in school and non-school community venues, for individuals or groups.

The Clinic-in-a-Box scheme has been operating in many secondary schools in Bath and North East Somerset for the past 15 years. Due to the pressures of the Covid-19 pandemic, we modified the system to make sure 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; it was especially relevant when schools had to be closed.

Clinic-in-a-Box describes concisely what we do: the apparatus, technology, medicines and materials are transported in a container. Nursing staff:

• Conduct visits in car parks and hospital grounds;
• Carry out telephone assessment;
• Give advice to young people in the area;
• Issue contraception.

Service demand

As a team of school nurses, we recognised that young people were still sexually active despite lockdown. However, access to sexual health services was extremely limited. School clinics were closed and some pharmacies were unable to offer emergency contraception following face-to-face consultation due to social distancing restrictions of the pandemic. 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 these needs.

Our team knew that, with a concerted effort, we could provide a service that was safe, accessible and confidential. Many of our school nursing team were redeployed in the first lockdown so, with our numbers depleted, a high priority was to find 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 have an impact on their mental and physical health.

Project aims

Our key aim was to support young people with their sexual health needs during this challenging time, as there were no other sexual health services available to them. Our other aims were to:

• Effectively manage teenage pregnancies through pregnancy testing, and offering treatment if necessary;
• Minimise the risks of sexually transmitted infections;
• Maintain a reduction in conception rates for those aged <18 years by improving their access to contraception or emergency hormonal contraception;
• Maintain communication with young people, so they knew we were still available and could support their needs.

Implementation and collaboration

Communication was an important aspect of our project. We messaged young people who were already on our caseload via text messages. We also sent posters to pharmacies advertising our chat health service (a phone-in service), which allowed potential callers to have our contact details. Some of our team who were redeployed into the community still went that ‘extra mile’ and responded to requests for help from young people in their caseload, arranging to meet up with them at a location that was safe or to make a direct referral to a colleague.

From the start of the March 2020 lockdown, we began to discuss ways to reach the young people on our caseload. Those with whom we have regular contact know they can text their nurse if they need help, but we were concerned that students would not know what to do as schools were closed. It soon became obvious – through the amount of phone calls from young people unable to get hold of emergency contraception – that young people were struggling.

Virgin Care management was supportive of our initiative. They encouraged us to meet up with young people in unconventional places, and the public health team at Bath and North East Somerset Council was aware of our need to look outside the box if we were going to keep young people safe. We had to change how we were working to respond, especially to emergencies.

We wanted to be flexible in location, time and travel so 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 ran clinics in youth clubs. As a result, we worked closely with youth workers who still had contact with some young people so, if a young person was asking for emergency contraception, the worker would contact us. The assistance from youth club workers was also key in facilitating support for young people and helping us to find suitable venues where we could meet, such as youth-centre car parks, coach parks, schools and hospital grounds.

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

Challenges

The biggest challenges our team faced concerned confidentiality. Meeting young people in public spaces or their homes to give out contraception or pregnancy tests brought significant challenges. Our team was operating throughout the pandemic, which 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 up with 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 significant health problems for young people and hard work to achieve a solution in unusual circumstances came to 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 to which one of our colleagues had gone, he wrote the following to us:

“Paul Sheehan (commissioner) told me of your ‘extra mile’ adventure providing a desperate young woman with emergency hormonal contraception yesterday. An intervention that might have been truly life changing. It’s so nice to hear about things like that. I can’t say it’s surprising, because I know that you and your colleagues often pull out stops to help people who have the greatest need, but it is very gratifying, and I wanted to send my thanks to you.”

Another response came from a sixth-form student:

“Just wanted to say thank you very much for your help today! It was an amazing service, very efficient and good – I feel much, much better about it all now so thank you! :)”

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

Future plans

We would like to:

• Build on the special relationship we have established with young people;
• Be more flexible in our meeting venues;
• Encourage schools to be more open and receptive towards sexual health.

Our desire is that schools understand that, when young people are concerned about their sexual health, there could also be consequences on their mental health and education.

Despite the difficulties of the Covid-19 pandemic, with pupils being in bubbles when back at school, we managed to conduct assessments via Microsoft Teams to advise young people and we managed to issue contraception. It has been a memorable journey, which deserves to be shared 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.