A nurse led service at a college increased access to sexual health services
Lindsay Sands, SRN, RM, FPCert, BA, is clinical outreach team leader, Sexual Health Services, Wheatbridge, Chesterfield.
Sands, L. (2009) Setting up a sexual health one-stop-shop for young people at college. Nursing Times; 105: 36, early online publication.
This article describes the development of a nurse led drop-in sexual health service in a further education college. It looks at the issues for practitioners to consider when setting up a nurse led clinic in this environment and the importance of working in partnership with education and youth services.
Keywords: Sexually transmitted infection, Health promotion, Screening, Young people
- This article has been double-blind peer reviewed
The young people’s outreach nurse specialists working within the sexual health service and based at Wheatbridge Health Centre in Chesterfield decided to identify how sexual health services provision being offered to young people could be extended and improved in terms of accessibility and acceptability.
The Wheatbridge outreach approach
Our aim was to meet the sexual health needs of young people in a venue that was not in a conventional health centre setting. This focus was in line with Our Health, Our Care, Our Say (DH, 2006), which identified that many sexual health services can be delivered effectively in nurse led community settings.
An opportunity to deliver a service at a FE college was identified in North East Derbyshire.
This initiative dovetailed well with the teenage pregnancy and chlamydia strategies (DH, 2001), which recommended the development of comprehensive and integrated sexual health services.
Our approach also followed recommendations in Improving Access to Sexual Health Services for Young People in FE Settings (DH and Department for Children Schools and Families, 2007) which identified a need for on-site, confidential and accessible sexual health services in FE colleges.
Selection of a college
We decided to offer an on-site sexual health service to the student population within the local FE college - Chesterfield College - and its partner campus in Clowne in Derbyshire.
Chesterfield College currently has 9,000 students registered in and around the North East Derbyshire District. The young people, aged 16-25, are spread across FE and higher education levels and 12.5% have learning difficulties.
Derbyshire is semi-rural and has many villages and towns where access to specialist contraceptive services is limited. The Bolsover district, where Clowne campus is based, has been identified as an area of deprivation and needs accessible and comprehensive sexual health provision as it has a higher than average rate of conceptions in women under the age of 18.
Strategies aimed at reducing the number of unplanned teenage conceptions in the UK must be broad based, link partnership agencies and facilitate an understanding in young people of the relationship between their freedom of choice, their self-esteem and sexual activity.
The Wheatbridge outreach team acknowledged that the education and health services would need to cooperate closely if they were to provide a comprehensive service for young people.
Identifying factors critical to success
Work on the project began in May 2007. There is limited evidence about the views of young people on what they feel constitutes appropriate or easily accessible sexual health service.
We decided to consult with students and staff before the service started. This consultation revealed an overwhelmingly positive response from the students to an on-site sexual health service. In our experience, young people are concerned about confidentiality and access to services and these issues were addressed in advertising the service and during personal encounters with young people.
The NHS Improvement Plan (DH, 2004b) recommended developing flexible access to services around individuals’ needs and preferences, rather than expecting people to fit around the system.
It was anticipated that consultation with students about issues of service development such as timing, location and staffing would improve access and reach even the most marginalised and vulnerable groups.
Developing partnership working
We were successful in bidding for funding from the strategic health authority for equipment and specialist nursing hours and the team negotiated with the college staff to store clinical equipment and contraceptives on site.
This had to be done with sensitivity, as some college staff did not immediately welcome the service. A significant number of lecturers indicated that they believed the primary role of the college was to deliver the educational curriculum, and that the provision of sexual health services was not a priority.
There was also reluctance on the part of some staff to allow the outreach team access to rooms in which the sexual health service could be delivered.
However, in spite of these difficulties, enthusiasm among key staff members at the college was vital in enabling the team to begin the drop-in sessions at both college sites in the week commencing 7 January 2008.
Delivery of drop-in service
Weekly services are provided at the two sites and is delivered by clinical nurse specialists working in partnership with the college and youth service.
The youth service is run by Derbyshire County Council and their trained youth workers both develop and participate in projects and activities for young people between the ages of 13-25.
Both sites provide the full range of contraceptive options, including the fitting of contraceptive implants and intrauterine devices/systems, in accordance with NICE (2005) guidelines, which stated that increasing uptake of long-acting reversible contraception would reduce unintended/unwanted pregnancies.
Sexually shared infection screening, treatment and contact tracing is also offered. This extended provision of the clinical contraceptive services has never been offered in outreach clinics in FE settings in Derbyshire before.
Information sharing with the students via the intranet, including PowerPoint presentations on sexual health issues, has been particularly successful. Students with questions about their sexual health can also contact the outreach nursing team by email.
Initial results and growth
Initial estimates of the numbers of young people using the service were quickly exceeded. It had been anticipated that the service might receive 3-6 clients per session, which would reflect attendances at other community projects.
Within weeks, the staff were seeing more than double the numbers of students who were expected to attend and could expect to consult with as many as 12-24 students at each one-and-a-half-hour session.
At the larger Chesterfield College site, we had to negotiate to use an additional room so two nurses could work at the same time.
The success of the drop-in service has increased the numbers of students participating in the national chlamydia screening programme. The team has offered stand-alone chlamydia screening days which have been very successful, exceeding the targets set by the PCT and in line with the national chlamydia screening programme guidance notes (HPA and DH, 2005). This recommended screening 50% of the total sexually active 15-24 year old male and female population.
The total number of young people accessing the services between 7 January 2008 and 18 December 2008 was 1,940 (Fig 1).
In addition, young people - predominantly males - accessed advice and support via the youth service at both college sites. This is atypical even in sexual health services, as young men generally perceive such services as being for women or as a place to obtain a supply of condoms.
Male youth workers deliver twice-weekly sexual health provision in addition to our clinical sessions. They are trained by and work in partnership with the outreach team. The youth workers are crucial in referring young people to the nurse specialists if they require clinical services, for example, treatment of a sexually shared infections or prescription of a contraceptive. Due to demand, the youth service provision will be extended.
After the first year of service provision, education and health services produced an evaluation questionnaire which was sent to all students, asking for their opinion of the services, timings, location, staff and suggestions for changes or improvements.
Over 1,500 questionnaires were returned and the results were overwhelmingly positive in their appraisal of the staff and services offered.
Many students wished to see the service extended to every day.
The major criticism was that students often had to wait to see staff, because of the large numbers attending - an issue which will be addressed with the recruitment of additional staff.
The outreach nursing team is now viewed as an important partner within the colleges. The recent college OFSTED inspection commended the college for its visionary approach to sexual health. Continued negotiation with college staff and awareness-raising among students has been a key factor in the success of this project.
The outreach team has been invited to contribute to the development of a robust sexual health strategy within the colleges and is now an accepted and visible presence at college open days and at freshers’ week.
We are liaising with learning disabilities services and the education services to develop a sexual health strategy to support vulnerable students with statements of educational need.
In the first year of service, we have already increased the number of clinical sessions we can offer to twice weekly in each college. College staff are learning how to respond positively to the needs of students who present with concerns about their sexual health.
These developments have worked because of the partnership with the education service, the youth service and also Derbyshire sexual health promotion service, which specialises in supporting gay, lesbian and transgender young people, and who also support us in delivering the stand-alone chlamydia screening days.
The most recent development has been the recruitment of young patients and public involvement volunteers aged 14-21. Following training, they are now successfully working in outreach settings with trained members of staff to engage with young people and offer support and education.
We hope to develop the young people who have a particular aptitude or ability to become peer educators, to complement the skills of clinical outreach team.
Recognition of success
The continuing development of the service is a major achievement but our greatest satisfaction lies in the positive change that we have created in attitudes towards the impact of sexual health issues on young people’s lives and educational prospects.
Key points for setting up a sexual health service At an FE college
- Develop close cooperation and partnership with education, youth and health services.
- Survey the young people target group to discover what they perceive to be the critical factors for success.
- Use of volunteers from the Patient and Public Involvement Programme increases the impact of the initiative
- Link to national chlamydia screening targets.
- Negotiate specialist nursing hours and equipment.
- Negotiate storage of equipment and drugs on site.
- Be prepared to offer adequate and appropriate training to college staff
- Be flexible, adaptable and willing to change the service to meet the demands of young people.
Department of Health and Department for Children, Schools and Families (2007) Improving Access to Sexual Health Services for Young People in Further Education Settings.
Department of Health (2006) Our Health, Our Care, Our Say.
Department of Health (2001) Better Services, Better Health, Better Sexual Health. The National Strategy for Sexual Health and HIV.
Health Protection Agency, Department of Health (2005) Performance Measures for the National Chlamydia Screening Programme. Guidance Notes.
Medical Foundation and Sexual Health (2005) Standard 5: access to services. In: Recommended Standards for Sexual Health Services.
NICE (2005) Long Acting Reversible Contraception.