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Section two: Promoting respect and responsibility
Key points
- Parents and carers are key partners in promoting sexual health and wellbeing.
- More teachers are being trained to be confident in delivering sex and relationships education and promoting good sexual health.
- Work is ongoing to engage with all people in Scotland, regardless of race, ethnicity, sexual orientation, age, disability or religion.
- Sexual health can be influenced by economic, social and cultural issues.
Last year we reported that the foundations were being laid to promote the key principles underlying the sexual health strategy, namely respect for self and others as the basis of good relationships and sexual health and wellbeing.
Work has continued across Scotland to try to ensure that everyone has access to good sexual health information and advice on which to base decisions, regardless of where they live and who they are. That means not discriminating against people because of lifestyle or on the basis of race, ethnicity, disability, age, sexual orientation or religion. It also means ensuring that education, information and services take into account that not everyone is the same.
This year we can also report that almost all NHS Boards have drawn up and implemented the findings of equality and diversity impact assessments. Those that have not completed this are in the process of doing so.
Central role of schools
Research shows us that schools are a key source of information about sexual health, wellbeing and relationship matters.
Nationally and locally work was stepped up throughout 2006-2007 to support teachers and others in delivering effective sexual health and relationships education.
This included an increase in the number of teachers, school nurses and youth workers undergoing sexual health and relationships education ( SHARE) training or local equivalents as well as more people being trained to deliver sex and relationships education in the classroom and other settings.
Sex and relationships education is expected to be boosted in 2007-2008 following an announcement from the Scottish Executive of £630,000 additional funding for this year and next from the education budget. This is expected to fund training for an additional 800 teachers and those who work with them. Local authorities submitted proposals on how they would spend the money at the end of June 2007. The majority of these have been accepted and discussion is ongoing with authorities where clarification is needed.
Case study
Schools in West Dunbartonshire using film-making, dance and music to tackle sexual bullying
Pupils in West Dunbartonshire have helped produce a DVD called Sexual Bullying, Name It and Shame It as part of a programme which is to be rolled out to secondary schools across the local authority area.
The programme, which aims to challenge gender stereotyping and sexist and homophobic bullying, used dance, music and film-making to engage young people in the issues.
The DVD explores young people's views on gender stereotyping, behaviour and sexual bullying, based on a list of statements created by young people, describing ways of challenging sexual bullying. These include: 'When you call someone a name, think about how it will affect them. You might think it is harmless but they might not.'
The Reduce Abuse Project, part of the council's Violence Against Women Partnership, which works with children and young people to challenge attitudes around domestic abuse and gender-based violence, developed the initiative along with young people, teaching staff and the Arts in Education Programme.
Teaching staff also took part in a staff training programme on sexuality and young people.
Evaluation has been positive with young people and staff having a greater knowledge of sexual bullying, how they challenge it and where to get advice and support.
Case study
Training for trainers moves SHARE in Highland up a gear
In 2006-2007, Highland Council significantly increased its work around delivering the SHARE sexual health and relationships education programme. Although SHARE had been delivered in some schools in the area in 2000, this was patchy, mainly because there were too few people trained to do it.
To address this, Highland Council promoted a Training for Trainers course, which was delivered in the region in Autumn 2006.
Twelve people took part, including seven from Highland and one from Argyll and Bute. Participants were from a variety of backgrounds, including health promotion staff, Health Promoting Schools staff, school nurses and youth development officers.
There is now a core of nine staff in the NHS Highland region, including Argyll and Bute, trained to deliver SHARE Training.
Highland Council has also used money from Respect and Responsibility funding to ensure that all schools can develop or improve school-nurse led drop-in facilities. Although these provide generic health advice, they have a particular focus on sexual health. Pupils are also given information on how to access services as part of the SHARE programme - a move based on results from previous evaluation of the SHARE programme and on action for all health boards from Respect and Responsibility.
Involving parents and carers
Children and young people value advice and information on sexual health and relationship issues from parents and carers. Work to support parents in this has been taking place both locally and nationally and has particularly involved encouraging schools and parents to work together to complement the information provided by each. For example, parents were closely involved in designing a new resource published by NHS Health Scotland, ensuring that it met their needs (see case study).
Case study
Schools and parents working together in Fife
Parents, teachers and other school staff in Fife have the opportunity to attend sessions to help them build confidence in discussing issues related to sexual health and to drug misuse.
The Parent Education Initiative is a joint project between the Health Promotion team at NHS Fife and Fife Council Education Service.
The workshops are mainly aimed at parents of children who are in Primary 7 and offer strategies to help them discuss topics relating to sexual health which may arise as the children grow older.
Feedback from the courses has been extremely positive, with comments including: 'Excellent course', 'Helps in talking to my child and to be more open' and 'Helped me look from a different perspective'.
In 2006-2007 the Parent Education Initiative provided 38 sexual health workshops to 306 parents in 32 schools as well as 24 drug and alcohol workshops to 192 parents in 20 schools.
In addition, they contributed to training for teachers, school nurses and youth workers and were involved in parent evenings and health days in primary and secondary schools.
Case study
Health Scotland involving parents in designing materials
A group of mums and dads has helped draw up a new resource which aims to help parents and schools work together in sex and relationships education.
The document was published by NHS Health Scotland in summer 2007.
'We decided to take a new approach and involve the people who would be using the resource at a very early stage,' explains Shirley Fraser, sexual health lead with NHS Health Scotland. 'So we got a group of mums and dads together with the designer and, by the end of the day, we had something they were happy with. It's part of our aim not just to consult parents and carers but to involve them directly in the process.'
The document was developed using the 'Writeshop' method, a workshop that brings together the target audience, topic experts, editors and designers to produce a publication in a short time, usually one day.
'Feedback from parents suggests that they all appreciated the opportunity to be involved in developing a resource they will actually use,' adds Shirley Fraser.
Learning about relationships and sexual health in school and at home: Information for parents, has been distributed to schools and is available to download at www.healthscotland.com
Equality and diversity
NHS Boards, local authorities and other agencies across Scotland are introducing ways of reaching out to and providing better services for minority ethnic groups. This includes looking at better provision for the recent increase in migrant workers from Eastern European countries as a result of EU expansion. For example NHS Grampian has started this process by completing a health needs assessment of migrant workers, relating to termination of pregnancy. A number of NHS boards are translating their information leaflets into languages including Polish and a Polish-speaking clinical support worker is now based at NHS Lothian's sexual and reproductive health service (see case study). In NHS Borders in 2006-2007, a number of outreach programmes were opened, particularly targeting areas with large migrant populations and temporarily homeless accommodation.
Work is also going on at national and local level to address the sexual health needs of people with learning disabilities. This is an area where partnerships, between health, local authority and voluntary organisations is particularly important, and this is reflected in several examples of joint working across the country. For example, Healthy Respect and Caledonia Youth held an event on sexual health and relationships for young people with learning disabilities (see case study).
The needs of LGBT people are also being addressed, again often through partnership working. For example, NHS Grampian is working with the Terrence Higgins Trust to deliver a number of programmes, supporting not just gay men but lesbian, bisexual and transgender people and those affected by HIV regardless of sexuality (see case study). In Borders LGBT Youth has employed a full time Youth and Community Development Worker who will, among other things, undertake joint training sessions with NHS Borders' newly appointed senior health promotion officer for sexual health and blood borne viruses ( BBV).
Case study
Sexual health lessons taught through drama
Young people with learning disabilities used drama to explore issues concerned with sexual health and wellbeing.
The project at Kilpatrick Special Education Needs School in West Dunbartonshire was the result of joint working and has had extremely positive feedback.
The Health Promoting Schools Unit, Community Health Partnership, fpa and the Cultural Co-ordinator Team, worked with teaching staff to develop the school's sexual health and relationships education programme.
They decided to use drama as previous health education projects had shown that it is an effective way to engage young people.
The project, led by the Community Health Partnership and the Family Planning Association, involved a group work programme which explored assertiveness, peer pressure, personal safety and relationships. The young people then worked with a drama worker to create a short performance on the issue.
The performance was shown to pupils and parents, who were encouraged to engage with the topic.
Feedback was very positive with young people saying it had increased their understanding of issues such as personal safety, vulnerability and relationships. Comments included: 'The message we learned was to tell our parents what we are doing and where we are going' and 'We shouldn't go with strangers and the wrong crowd'.
Case study
Health Scotland working to improve the sexual health of minority groups
One of NHS Health Scotland's responsibilities under Respect and Responsibility is to disseminate evidence, commission research and develop resources to support the ongoing implementation of the strategy.
It also has a specific remit to facilitate awareness of the sexual health needs of people with learning disabilities and make recommendations for research-based programmes and materials.
In February 2007, NHS Health Scotland organised a strategic seminar to consider sexual health and wellbeing among young people from black and minority ethnic ( BME) groups and those with learning disabilities ( LD).
Around 60 delegates representing NHS and local authority planners and commissioners, policy makers and other agencies attended. They heard the latest information on research commissioned by Health Scotland around the sexual health needs of each group. Then the delegates were given the chance to discuss the findings and seek ways forward.
The national strategic seminar has been followed by a series of regional meetings, which have focused on how practitioners see the research findings supporting practice locally.
Shirley Fraser from Health Scotland says: 'Respect and Responsibility wants action to address the sexual health needs of all, but we know there are some groups which do not have the same access to services and information as others. The research we commissioned shows some of the current gaps but also suggests ways forward around improving service access and sex and relationships education as well as different ways on engaging with young people.
'These are ongoing pieces of work and the seminars play an important part, both in sharing and disseminating research findings but also in helping people to talk to each other and find ways of working together to improve sexual wellbeing of all young people.'
Needs of people with learning disabilities being addressed in Tayside
The sexual health needs of people with learning disabilities are being addressed by NHS Tayside with an intensive inter-agency training programme for parents, carers and workers in both the statutory and voluntary sectors.
The course provides those taking part with a better understanding of the needs of people with learning disabilities and encourages agencies to work together to create a network of local expertise.
Partnership working in Fife to meet needs of BME communities
Action is being taken in Fife to try to ensure that people from black and minority ethnic communities have access to sexual health services and that their needs are being monitored and met.
Fairness Race Awareness and Equality ( FRAE) Fife, a voluntary agency, is represented on the Fife Sexual Health Strategy Group and, in early 2006, a joint meeting was held between FRAE Fife and the strategy group and BBV Task Group to consider issues faced by BME groups in the kingdom.
As a result, the strategy group agreed that services should monitor use by ethnic group, have processes to arrange translation of written information and to access interpreters where required. The group also agreed that all staff should have received basic equality and diversity training as a minimum and that specific staff training should be provided where client groups had specific needs.
Promoting condom use among gay men in Grampian
Gay men in Grampian are being urged to use condoms as part of a campaign run by the Terrence Higgins Trust. The 'Get it On' campaign, aimed at normalising the use of condoms, was launched in May 2007, using the promotional message that '9 out of 10 gay men use condoms'. Resources including condoms, packs, posters, Exposed magazine and other items branded with the 'Get it On' logo have been distributed through various venues including gay bars, LGBT student associations at local universities and via PRIDE Aberdeen.
Case study
Polish worker in Edinburgh family planning service
A Polish-speaking clinical support worker has started work at NHS Lothian's Family Planning Service in Dean Terrace, Edinburgh, to help meet the needs of Polish women living in the capital.
Funding from the City of Edinburgh Council to promote social inclusion has been used to pay for the worker, who is on hand at two evening and one day-time clinic per week.
Lead clinician Professor Anna Glasier says the move was much-needed. 'We find that we are seeing a lot of women from Poland, at least 10 a day. Some of them speak very good English, but some of them don't.
'We were never entirely sure that the patients were having their needs met because we couldn't be certain that they understood what was happening.'
Employing an interpreter is expensive and in any case staff couldn't predict when one would be needed. Employing a Polish-speaking clinical support worker, who would be trained in general healthcare assistant tasks, but would be available to translate if required, seemed a good way to meet the needs in an appropriate and efficient way. The role - which will be audited - was planned and developed in 2006-2007 and the member of staff started work in September 2007.
The service is advertised with a sign in Polish at the Dean Terrace reception and it may in future be publicised on Polish websites.
Case study
Working together to provide better information
NHS Health Scotland and the LGBT Centre for Health and Wellbeing worked together to provide two new resources to help meet information gaps.
The first, a leaflet raising awareness of the need for cervical screening among lesbian women, was drawn up in response to feedback from women themselves and with their active involvement in the text and design.
'Many professionals assume that cervical screening is not required,' says Health Scotland's Shirley Fraser. 'But lesbian women may also be at risk of STIs, including HPV, which can lead to cervical cancer.'
The second is a booklet providing information on transgender issues, which has been built from an earlier Lothian-based resource. 'Many young people who choose to undertake gender reassignment, for example, are not aware of the process or support that is necessary to achieve this,' says Ms Fraser.
'It is equally an information gap for their parents and other family members as well as professionals.'
The booklet is available from the LGBT centre and other LGBT agencies and provides information on what it means to be a transgender young person and how professionals and families can support them.
Case study
Reaching out to men involved in prostitution in Glasgow
The Open Road project, aimed at men involved in prostitution, has been launched in Glasgow.
Funded with £100,000 of national strategy money over three years and augmented by an allocation from the blood-borne virus prevention budget, the intention is to respond better to the needs of this group.
Men who exchange sex for any form of payment, including money, drugs, consumer goods or even a bed for the night, can access the service, which is based at the Glasgow LGBT Centre in Bell Street.
The service can provide emotional support and advice, access to a wide range of services and fast-track access to STI testing.
Activities include establishing contact with men involved in prostitution through outreach and creating referral pathways with other key services, such as addictions and housing; forming care plans and working with mainstream services to enhance knowledge of male prostitution issues.
Case study
improved services for people with addiction problems in Lanarkshire
Steps are being taken to help meet the sexual health needs of people with addiction problems in Lanarkshire.
The lead clinician and lead nurse have been working with local drug misuse and harm reduction teams to improve access to services for this hard-to-reach group.
'The needs of contraceptive provision and sexual health screening, including blood-borne virus and HIV testing, for clients with addiction problems are well-recognised,' says lead clinician Dr Anne McLellan.
'But as many of these clients can have chaotic lifestyles, an appointment system isn't the best mode of service provision for them.'
A small business card has been designed, which has the sexual health service logo and a phone number on it. This will be given to clients with addiction problems allowing them to 'drop in' to certain clinics.
'Clients fast-tracked in this way will be seen by an experienced doctor and offered a full range of contraception and STI testing,' says Dr McLellan.
A leaflet with more information has also been written and can be given to the client.
The lead clinician and lead nurse have given a lunchtime presentation to more than 80 staff who work with clients with addiction, which was well-received.
It is expected that similar services will be provided for other vulnerable groups, such as homeless people, looked after children and those with learning disabilities.
Wider influences on sexual health
Changing cultures: media and communication
Across Scotland, NHS organisations, local authorities and others have been making use of new - and old - technology as part of the long-term process of culture change. Some have employed websites to raise awareness of sexual health services and issues (see case studies) while some have been proactive in seeking media coverage of their plans.
Case study
Public involvement in new website in Tayside
Patients and the public had a strong say on the content of a new sexual health and wellbeing website launched in Tayside in February 2007.
The website, www.sexualhealthtayside.org, was developed by the multi-agency Sexual Health Strategy Group and is designed to cater for people of all ages.
It was set up to respond to requests from local people for up-to-date information and advice about sexual health and relationships.
The website provides online information about access to services and guidance on how to talk openly and honestly about safer sex. It also has a section devoted to the needs of parents and carers.
Members of the public had direct input into development of the site, which was tested by focus groups and survey questionnaires before it was launched.
The website tries to tackle equality and diversity, with, for example, links to translation services in a number of languages including Chinese, Hindi, Arabic and Urdu and a section specifically on sexual health and disability.
There is also a link to a directory of sexual health services offered in Tayside.
Case study
Consultation process is raising awareness in the Western Isles
The Western Isles Sexual Health Committee, a multi-agency group including representation from the NHS Board, local authority, voluntary organisations and parents, has published its own local strategy following extensive consultation.
The strategy is based on the recommendations of the national document, Respect and Responsibility, and has been formally accepted by Western Isles NHS Board, Western Isles Community Planning Partnership and Comhairle nan Eilean Siar.
It was generally well-received during a wide consultation process.
'One of our priorities has been to ensure that the strategy is well-publicised and that people know about it,' says Isabel Steele.
'The consultation process itself, which included presentations to community groups, raised public awareness and a launch of the final strategy with media coverage also helped.'
Moving forward with new technology
Case study
Lanarkshire to pilot national IT system
NHS Lanarkshire will be the first NHS Board to adopt a national IT system for sexual health. Considerable progress was made in the last year as it prepared to be a pilot site.
At the start of 2006, there were no computers in use in any clinical sites in family planning or GUM. By the end of 2006-2007 there were computers and printers in every site and internet access for BASHH (British Association for Sexual Health and HIV) guidelines was available.
'As regional protocols evolve, they will be accessible in every site and will be updated regularly,' says lead clinician Dr Anne McLellan. 'Soon all staff will be able to access their emails from all clinical sites, saving time in the office. This generally increased availability and use of computers is preparing staff for ultimately a paper-free service and also encouraging them to look up information online.
'This will ensure patients are treated in line with up-to-date guidelines and information.'
Other moves include introducing an electronic diary system to help develop a centralised booking model in GUM and Family Planning and ultimately there will be one telephone number to access all sexual health services across Lanarkshire.
Working with faith groups
There are people from many different faith backgrounds in Scotland and this is being taken into account when developing both education programmes and services. Faith groups have been actively involved in developing sexual health and relationships education and policies. There is also faith representation on both the National Sexual Health Advisory Committee and on many local strategy groups across Scotland.
Case study
Progress on Called to Love
Called to Love, a relationships and moral education programme for Catholic secondary schools, has now been piloted.
Developed in partnership by Healthy Respect and the Scottish Catholic Education Service, the programme aims to offer young people attending Catholic secondary schools the opportunity to be fully informed about sexual health matters by placing relationships education within the context of love, respect, responsibility and moral choices.
During 2006-2007, Called to Love teaching materials were piloted in Catholic Secondary schools in Lothian and in the West of Scotland, and will be published later in this school session for use in all Catholic secondary schools in Scotland.
The Called to Love project's aims include developing curricular guidance and appropriate resources on relationships and moral education, developing and delivering staff training, and evaluating and reviewing the pilot materials.
Guidelines already published by the Catholic Education Commission around relationships and moral education are at the heart of the materials produced by the project.
Michael McGrath, Director of the Scottish Catholic Education Service, says: 'The Called to Love project has demonstrated how the two agencies have been able to work together, showing respect for each other's roles and meeting the responsibility of supporting young people in ways appropriate to their particular context.'
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