Improving sexual health services to protect children

Sue Bunn, Commercial Director of Inform Health, explores how sexual health services are being improved to better protect children from harm.

A independent assessment An investigation into child sexual exploitation (CSE) in Rochdale, published earlier this year, found ‘compelling evidence of widespread organised child sexual exploitation’ and highlighted serious failings by multiple agencies across Greater Manchester.

The Rochdale Crisis Intervention Team (established in 2002 to provide advice and support to young people on sexual health) has played a key role in identifying and preventing CSE in Rochdale and has also highlighted the role of sexual health in protecting vulnerable young people.

Understanding the scale of the problem

According to police recorded crime data, 17,486 crimes involving child sexual exploitation were recorded by police in England and Wales in 2021/22. This was a 10% increase on the previous year and an average of 48 offences per day.

While it is common for young people experiencing this type of abuse to opt out of many statutory services, sexual health services often provide a safety net, says Dr Karen Rogstad, HIV and sexual health advisor at Sheffield Teaching Hospitals NHS Foundation Trust: ‘Because of the type of abuse that is being perpetrated, exploited young people continue to access sexual health services. This provides us with a unique opportunity to identify and prevent harm.’

Data collected between 2019 and 2021 shows that the number of CSE cases reported by sexual health services increased by 103%. However, this can be partly attributed to the progress sexual health services have made in improving the way vulnerable patients are treated and information is collected.

Foregrounding protection in sexual health services

In 2014 The British Association for Sexual Health and HIV (BASHH), in collaboration with Brook and with the support of a multi-agency advisory board, working group and input from young people, produced Recognizing signals.

Dr. Rogstad, co-author of Recognizing signalsexplains the premise: ‘It is designed to provide a robust, standardised approach to support healthcare professionals to better identify young people attending sexual health services who are at risk of experiencing CSE. It has been shown to be an effective tool in enabling frontline staff to follow their professional curiosity, capture important information and ultimately protect children from harm.’

Reflection of the changing landscape

Recently updated to reflect the changing landscape of CSE, the Recognizing signals The tool is now also suitable for tackling child criminal exploitation (which is often associated with CSE) and is designed to work more effectively in remote consultations.

Dr Dawn Wilkinson, Sexual Health and HIV Advisor and Lead for Young People’s Sexual Health and Contraception Services at the Jefferiss Wing, Imperial College Healthcare NHS Trust, who works on the Recognizing signals The Project Team Board, representing the BASHH Adolescent Sexual Health special interest group, notes the following:

‘Sexual health plays a special role in advocating on behalf of young people. We have used the renewal as an opportunity to engage with young people to ensure we continue to understand and address their needs. The safeguarding landscape has changed dramatically over the past decade, so this new version, developed following an extensive stakeholder engagement process, will help professionals understand the key concepts behind its use and apply a best practice, trauma-informed approach to identifying the signs of abuse and taking appropriate action within a multidisciplinary team.’

The financing problem

The introduction of the updated tool and the subsequent rollout of training can only help so much. It is crucial to ensure that sexual health services can effectively perform this protective function, as Dr Rogstad points out: ‘Services need to be properly funded so that they can see vulnerable young people in person. They need to be empowered to spend sufficient time at appointments so that rapport can be built with young people and the right questions can be asked in the right way. It is also vital that other agencies, including social care, can process referrals from sexual health services.’

But while demand for sexual health consultations has increased by a third since 2013, funding has not kept pace. According to a recent analysis by the Local Government Association, public health funding has fallen by £880 million in real terms since 2015.

Insight into the question

So how do sexual health services do more with less? According to Dr Wilkinson, the first step is to understand demand so that future provision can be targeted appropriately and factored into local government commissioning processes.

‘There is a tremendous amount of work being done on data protection in sexual health care, but if it is not recorded properly, coded incorrectly or simply not entered into the reporting systems, it goes essentially unnoticed.’

Dr Wilkinson continued: ‘This means it is invisible to commissioners and without the data to demonstrate demand it is difficult to make a strong case for increased funding. By standardising safeguarding codes and entering them into an electronic patient record system after each consultation, we can effectively report on activity figures and use this as an indicator of the safeguarding workload occurring within sexual health services. It could also open up conversations with commissioners about the benefits of moving to fee-based safeguarding payments that better reflect the work that is taking place and ensure that services can appropriately fund safeguarding activities in the future to keep children safe.’

Identifying patterns across regions

The move toward specialized integrated sexual health services promotes better patient access and outcomes. The model is designed to improve sexual health by “providing nonjudgmental and confidential services through open access, with most sexual health and contraceptive needs met in one visit, often by one health professional, in services with extended hours and locations.”

However, these models can also complicate the task of monitoring vulnerable patients. For example, exploited youth can be deliberately moved to multiple clinic locations by perpetrators seeking to conceal their abuse.

As providers offer integrated sexual health care, individual providers inevitably merge to cover larger geographic areas. And while this is great news for patient access, it can make it easier for victims, or those at risk for CSE, to slip through the net.

Appropriate data sharing is essential to prevent this problem. Tools that provide access to answers to questions asked in previous encounters and allow the clinician to discreetly compare them with answers given today make it easier for professionals to compare information, identify patterns, recognize signs of abuse, and take meaningful action.

Offers a mix of access options

These are some of the ways in which technology is supporting protection efforts in sexual health services. Another way is through optimised service management, ensuring that vulnerable patients, who may be at risk of CSE or have complex needs, have access to specialist care and support face-to-face. Achieving this in the face of the current funding gap is difficult, but by enabling patients who are capable of self-management to independently access and manage more services – such as STI testing, treatment or contraception – it is possible to free up clinic resources without compromising outcomes for any single patient group.

Dr Wilkinson agrees: ‘Flexibility is essential when prioritising access for all and meeting safeguarding responsibilities. Digital technology is not for everyone and there is good evidence to suggest that young people still want to be seen in person. In the absence of an increase in public health funding, offering a mix of access options will support sexual health services to better meet increasing demand, provide a safe space for exploited young people and invest the time and resources needed to educate, identify and prevent CSE.’