/ CHHS17/238

Canberra Hospital and Health Services

OperationalProcedure

Adolescent Sexual Health Care – School Health Nurse

Contents

Contents

Purpose

Scope

Section 1 – Background

Mature Minor

Section 2 – Sexual Health Consultation

When the young person is not sexually active, the School Youth Health Nurse will:

When the young person is sexually active, the School Youth Health Nurse will:

The School Youth Health Nurse will provide follow up by:

Documentation

Related Policies, Procedures, Guidelines and Legislation

References

Definition of Terms

Search Terms

Attachments

Attachment A: Sexual Health History

Attachment B: Sexual Health Risk flow chart

Attachment C: Chlamydia screening process

Purpose

To provide a procedure to assess the need for sexual health care for young people who presentto the School Youth Health Nurse (SYHN) Program.

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This Standard Operating Procedure (SOP) describes for staff the process to

Scope

Scope

This procedure applies to Level 2 Registered Nurses working in the SYHN program, and also for student nurses working under Level 2 Registered Nurse supervision

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Section 1 –Background

SYHN provide developmentally appropriate, inclusive and holistic care that is focused on the health and wellbeing of young people. Each consultation is approached with respect and sensitivity. SYHN provide trauma informed care, with a strong focus on supporting young people to make healthy life choices.

The SYHN Program promotes and fosters the relationship between the young person and their care givers. The SYHN will aim to engage the support of parents and/or carers to facilitate the young person’s sexual health care.

The SYHN will be alert to concerns regarding consent and will practice within legislation for mandatory reporting.

Young people accessing the SYHN attend voluntarily.

Mature Minor

The SYHN is able to provide referral for contraception, sexual and reproductive health advice and treatment, without parent/carer knowledge or consent to young people provided that:

  • The young person understands the advice provided and its implications.
  • The SYHN believes that the physical or mental health of the young person would otherwise be likely to suffer, and so provision of advice or treatment is in their best interest.

Also the SYHN will follow the criteria commonly known as the Fraser Guidelines:

  • The young person is able to understand the sexual health care advice
  • The SYHN cannot persuade the young person to inform their parents, or the young person will not allow the SYHN to inform their parents, that they are seeking sexual health care
  • The young person is very likely to begin or continue sexual activity with or without the advisedsexual health care
  • Unless the young person receives sexual health care, their physical and/or mental health are likely to suffer
  • It is in the young person’s best interests to be provided withsexual health care without parental consent

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Section 2 – Sexual Health Consultation

On presentation to the SYHN the young person’s reasons for the consultation will be discussed, and a psychosocial assessment undertaken, including assessment of the need for sexual health care, education and/or referral.

The SYHN will discuss confidentiality and limitations giving consideration to mandatory reporting requirements. The SYHN will assess if the young person is able to consent to health care as a Mature Minor.

The SYHN will provide a safe and supportive environment for young people to:

  • Discuss sexual health, sexuality, development and relationships
  • Disclose unwanted sexual activity

When the young person is not sexually active, the School Youth Health Nurse will:

  • Consider the young person’s individual learning needs and developmental stage to provide targeted evidence based sexual health education
  • Discuss consent and respectful relationships
  • Aim to provide information on accessing sexual health care, for future needs, and for advising their peers
  • Advise the young person that it is normal and acceptable to not yet be sexually active
  • Encourage and normalise communication with parents/carers regarding sexual health

When the young person is sexually active,the School Youth Health Nurse will:

  • Complete a sexual history (prompts in Attachments A and B)
  • Consider the young person’s individual learning needs and developmental stage, and provide targeted evidence based sexual health education, including information on consent, respectful relationships, contraception, pregnancy, sexually transmissible infections, blood borne viruses, and screening - using a harm minimisation approach
  • Advise the young person that it is normal and acceptable to seek sexual health care
  • Encourage and normalise communication with parents/carers regarding sexual health matters
  • Encourage parent/carer support to access sexual health care, offering to support this communication if needed
  • Discuss condomless sexual activity if disclosed (see Attachment B)
  • Support access to chlamydia screening for all sexually active young people (Attachment A, B, C)

When a young person discloses unwanted sexual activity, the School Youth Health Nurse will:

  • Respond with empathy and:
  • Listen carefully,
  • Control expressions of panic/shock,
  • Tell the young person that they are believed,
  • Reassure the young person that telling their story was the right thing to do,
  • Tell the young person that what happened was not their fault,
  • Acknowledge that it is often hard to talk about unwanted sexual activity,
  • Advise the young person what the SYHN plans to do with the disclosure
  • Clarify if the young person is safe or if they have any injuries. Identify if there is the likelihood of further unwanted sexual activity
  • Enquire if the young person’s parent/carer is aware of the unwanted sexual activity. Seek consent to discuss with parent/carer, or to support the young person while they disclose. If young person declines consent, explore concerns, and encourage communication with parent/carer if safe for the young person to do so
  • Contact ACT Child and Youth Protection Services on 1300 556 728 and submit Child Protection Report as per mandatory reporting guidelines
  • With the young person’s consent consider contacting Rape Crisis on6247 2525 for additional support
  • With the young person’s consent consider additional support from a nominated school staff member for the young person within the school setting

If the SYHN is requested to give a statement to police they should refer to the ACT Medico-legal Coordination Team on 6244 3294 or email

The SYHN will contact the Schools Clinical Nurse Consultant or Central Manager for guidance.

The School Youth Health Nurse will provide follow up by:

  • Offering to arrange for sexual health care from a negotiated health service, and facilitating access to services as necessary
  • Arranging further appointments with the SYHN as necessary
  • Considering the need to provide further support for the mental health and wellbeing of the young person

Documentation

  • Document the consultation in the young person’s clinical record.
  • Record in SYHN data collection.

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Related Policies, Procedures, Guidelines and Legislation

Policies

  • ACT Health: Child Protection Policy
  • ACT Health: Consent and Treatment

Procedures

  • ACT Health: Clinical Handover Procedure
  • ACT Health: Canberra Sexual Health Centre, Operations manual.
  • ACT Health: School Youth Nurse - Mental Health Assessment and Referral Procedure

Legislation

  • Crimes Act 1900

Frameworks etc.

  • ACT Health: Child Protection Practice Paper
  • ACT Health: WYCCHP Clinical Reflective Practice Framework
  • Australian Sexual Health Alliance, Australian STI Management Guidelines for use in Primary Care
  • Department of Health 2004. Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health. London: Department of Health

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References

  1. Department of Health (2004). Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health. London: Department of Health
  2. ACT Government Community Services, Keeping Children and Young People Safe – a shared community responsibility (2014)
  3. Family Planning New South Wales, Family Planning Victoria and True Relationships and Reproductive Health 2016 Contraception: An Australian clinical practice handbook - 4th edition
  4. Goldenring JM, Cohen E. Getting into Adolescent’s Heads. Contemporary Paediatrics (1988) 5:75–90.
  5. Goldenring JM, Rosen DS. Getting into Adolescent heads: an essential update. Contemporary Paediatrics (2004); 21:64
  6. Australian Sexual Health Alliance, Australian STI Management Guidelines for use in Primary Care (2016)
  7. The Royal Australasian College of Physicians (2015). Position Statement: Sexual and Reproductive Health Care for Young People.

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Definition of Terms

Young person: student in ACT Education Directorate secondary school

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Search Terms

Sexual, adolescent, contraception, mandatory, mature minor, young person, School Youth Health Nurse, sex, sexually transmissible infections

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Attachments

Attachment A: Sexual Health History

Attachment B: Sexual Health Risk flow chart

Attachment C: Chlamydia screening process

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended / Section Amended / Approved By
Eg: 17 August 2014 / Section 1 / ED/CHHSPC Chair

Attachment A: Sexual Health History

Lifestyle Factors
Consider impact of alcohol or other drug use on sexual health / Discuss safety concerns: increased risk of sexual assault. Encourage young person to identify strategies to reduce risk, i.e. having a friend not using alcohol or drugs to keep them safe. Discuss issues around consent; if a person is affected by alcohol or drug use their ability to give or to negotiate consent is compromised.
Discuss increased risk of unplanned sexual activity, including condomless sex. Encourage young person to identify strategies to promote safer sex choices or reduce likelihood of unplanned sex.
Consider blood born virus risk / Unsafe tattoos or piercings?
Injecting drug use?
Living with family members with hepatitis C or B, or with a history of injecting drug use?
Born in high and/or intermediate prevalence countries for hepatitis B?
Male same sex attraction and HIV risk
Consider also risk of HIV related to living in high/intermediate prevalence country and/or sexual partners from these countries
Consider risk associated with social media and/or sexting / Are they in contact with people that they have never met? Has anyone asked to meet with them?
Have they ever been asked to send pictures online or as a text by someone that they don’t know?
Have they ever been asked to send naked pictures?
Have they ever received texts or images that have made them feel uncomfortable?
Discuss issues around child pornography and online safety. Encourage self protection strategies. Discuss legal rights if images have been used without their consent, or if they have been manipulated online or in text as a result of their pictures.
Follow mandatory reporting guidelines
Vaccination
Hepatitis B and Gardasil
Hepatitis B and Gardasil are included on the Australian Childhood Vaccination Schedule
All sexually active people are encouraged to be vaccinated against hepatitis B and human papillomavirus (HPV).
Hepatitis A: vaccination is recommended for sexually active same sex attracted males.
Available through GP or Canberra Sexual Health Centre.
Sexually Transmissible Infections (STIs)
Any STI screening in the past? When? / All sexually active young people are advised to have annual chlamydia testing.
All males who have had any type of sex with another male in the previous year should have an annual screen for chlamydia, gonorrhoea, HIV, syphilis and hepatitis B.
All other same sex attracted males with casual partners should have STI and BBV screening up to 4 times per year.
Promote partner screening.
Encourage young people to ask their partner/s if they have had a screen prior to sexual activity.
Sexual Activity
If sexually active are sexual partners male, female, other? / Provide a safe environment to discuss concerns or disclosures around sexuality and/or gender.
Informs needs for STI screening or contraception.
Does the young person have a regular partner or casual partners? / How long have they been with the regular partner? Have they been screened? Are they using contraception?
If casual partners as well as regular partner, is the regular partner aware? Encourage measures to protect the regular partner from STIs.
Is the young person having oral sex?
Are they using a condom? / If no condom use, and a male having oral sex with males, encourage STI screen.
Most STIs have a higher incidence in males having sex with males.
The risk of HIV transmission through oral sex is very low.
Encourage condom use for oral sex.
Is the young person having vaginal sex?
Are they using a condom? / Encourage a chlamydia screen.
Encourage the young person to consider how they would feel about a pregnancy?
Use the opportunity to educate on reproduction, contraception efficacy, promoting the benefits of LARC, emergency contraception, condom use and where contraception can be easily accessed.
If vaginal sex was in the last five days and no contraception was used, discuss emergency contraception. Use motivational interviewing to support choices young person to make informed choices.
Sexual Activity (cont)
Is the young person having anal sex?
Are they using a condom? / If no condom use, and a male having anal sex with a male, encourage STI and BBV screen.
If the last condomless anal sex was within 72 hours, discuss HIV post exposure prophylaxis (PEP) and phone Canberra Sexual Health Centre to discuss need for PEP on 6244 2184.
Use the opportunity to educate on high rates of HIV and other STIs with condomless anal sex. Stress the importance of condom use, regular screening, and having a conversation around HIV and STI screening with partners. Provide information on HIV pre-exposure prophylaxis (PrEP) to any young person at increased risk of HIV and refer to Canberra Sexual Health Centre if indicated.
For heterosexuals with no condom use for anal sex, educate on higher risk of STI. Annual chlamydia screening recommended regardless of condom use, which will need to include a rectal check for females.
Chlamydia/gonorrhoea
Blood born virus / One to two weeks window period.
Up to three months window period.
What are the young person and their opposite sex partner using for contraception? / Educate on Emergency Contraception and where to gain access.
Consider risk of pregnancy and organise referral for testing.
Encourage LARCs if suitable. Support access for contraception.
Provide condoms if available.
Consider education on fertility, pregnancy, and efficacy of different contraception options.
Any unwanted sex? / See Women Youth and Children Community Health Program, School Youth Health Nurse procedure on Adolescent Sexual Health Care
Follow Mandatory Reporting Guidelines
Hurt, hit or felt threatened by a partner? / Follow Mandatory Reporting Guidelines
Clarify if the young person is safe. Is the young person injured? Is there a likelihood of further violence or threat?
Consider referral to Domestic Violence Crisis Service on 6280 0900
Provide education around respectful relationships.
Provide support and validation.
Consider safety planning.
Menstrual cycle
When was the start of their last period? / Consider fertility or menstrual cycle education.
Refer for pregnancy testing if risk identified.
Any concerns with their periods?
Do they have pain that stops their usual activities?
Is their cycle regular? / Any bleeding between periods or after intercourse, refer to GP or sexual health service.
Consider stage of development.
Consider endometriosis or polycystic ovarian syndrome (PCOS).
Consider referral to GP or the Endometriosis Centre
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/238 / 1 / 24/10/2017 / 01/09/2022 / WY&C - CHP / 1 of 13
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
/ CHHS17/238

Attachment B: Sexual Health Risk flow chart

Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/238 / 1 / 24/10/2017 / 01/09/2022 / WY&C - CHP / 1 of 13
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
/ CHHS17/238

Attachment C: Chlamydia screening process

Process for SYHN to screen young people for Chlamydia
Equipment:
  • Swab for chlamydia PCR (polymerase chain reaction) testing and/or
  • Urine collection container if urine PCR
  • Bag for specimen
  • Personal Protective Equipment (PPE): gloves
  • Alcohol hand rub