4.6 Condom Distribution Protocol

ACKNOWLEDGEMENT

This Policy document was produced in May 2004 with the support of Health First and Southwark Social Services. It has been developed using material from Coventry Health Authority (as was) and Islington Primary Care Trust

Introduction
Values

Recommendations/Requirements for Partner Agencies:
Storage and Shelf Life
The Fraser Guidelines and Child Protection
Child Protection - Safeguarding Young People
Staff and Volunteer Training
Confidentiality
Distributing Condoms
Appendix 1: Good Practice Guidelines for Condom Distribution to Service Users

1. Introduction

1.1	This document provides guidelines to cover condom distribution for agencies participating in the Teenage Pregnancy and Sexual Health Strategy Distribution Schemes in Lewisham and Southwark. South East London has some of the highest teenage pregnancy rates in the country and similarly high rates of sexual infections and HIV. Condoms can be expensive, and many people are embarrassed to ask for advice about condoms in a pharmacy. In this context, the distribution of free condoms to young people is an effective and practical way of preventing further unplanned pregnancies and sexual infections. Providing condoms can also provide useful opportunities for sexual health promotion in safe and informal settings. These guidelines have been drafted to make condom distribution as effective as possible in promoting sexual health, providing birth control and in HIV prevention.
1.2	Although it is not against the law to provide young people under the age of 16 (the age of consent) with contraceptive advice or methods of contraception, it is important that services understand the present legal framework, and are familiar with standards of good practice.
1.3	Our recommendations/requirements of participating agencies come under 5 categories: Storage and shelf life The Fraser guidelines and child protection Confidentiality Staff and volunteer training Condom distribution
1.4	All services will be offered training, advice, resources and support in order to implement these guidelines. They also have a responsibility to work within this policy.

2. Values

2.1

The values of this policy draw on a positive, holistic and empowering model of sexual and reproductive health. We are committed to sexual health promotion which

Is accessible to all young people, and affirms their diversity
Enables young people to develop practical knowledge and skills
Enables young people to develop respect for others e.g. mutual consent to sexual activity
Supports the development of self-esteem
Actively challenges discrimination on grounds of gender, ethnicity, sexuality and ability

Recommendations/Requirements for Partner Agencies
(Under each heading, recommendations are in Italics)

Each Agency to Decide its Internal Protocol based on The Recommendations Below.

3. Storage and Shelf Life

3.1	That partner agencies are able to store condoms in cool, dry and dark conditions.
3.2	Condoms that are past their sell-by date will be used for demonstration purposes only.

4. The Fraser Guidelines and Child Protection

4.1	That participating agencies can demonstrate a working knowledge of the Fraser guidelines, and of child protection issues as they relate to condom distribution (see 4.4)
4.2	That partner agencies have copies of the guidelines on file and available to all staff and volunteers.
4.3	That when condoms are provided to under 16s, a condom demonstration is also offered.
4.4	People under sixteen years of age can buy condoms at pharmacies, and it is not illegal to supply condoms to people under the age of sixteen. Our understanding of The Fraser guidelines is as follows: Condoms and contraceptive advice can be provided to people under sixteen provided that: The young person understands the advice and has sufficient maturity to understand its moral, social and emotional implications The person providing the advice and /or condoms cannot persuade the young person to inform their parents, or allow the volunteer/staff member to inform their parents that they are seeking contraceptive advice The young person is very likely to begin or continue having sexual intercourse with or without contraceptive support and would be at risk of pregnancy or sexual infections Unless the young person receives condoms or contraceptive advice their physical or mental health will suffer The young person’s best interests require the worker or volunteer to give information about where to get contraceptive or sexual health advice or condoms or all options with or without parental consent. By way of summary, therefore, if the young person will be at risk of pregnancy or sexual infections, condoms should be provided.
4.5	The Fraser Guidelines describe good practice in providing young people under the age of sixteen with sexual health advice and services. However this does not exempt staff from their responsibility to follow the London Child Protection Procedures if it is known or suspected that the child will be put in danger from physical, emotional or sexual abuse, or might seriously harm themselves or others.

5. Child Protection - Safeguarding Young People

The following child protection considerations are recommended to ensure the rights of young people are safeguarded.

5.1	The age and understanding of the young person seeking the service to assess whether they are at risk, even if sexually active with peers.
5.2	Clear guidelines on no bodily contact and how to refer on for sexual health assessments.
5.3	Guidance on appropriate behaviour in one to one counselling over sexual health matters.
5.4	All staff operating the scheme to be Criminal Records Bureau checked and/or to have regular staff/volunteer assessments and supervision.
5.5	Clear Complaints procedures to operate for young service users
5.6	Clear selection process for those who will operate the scheme, e.g. workers to have undertaken the Condom Distribution Training, be Criminal Records Bureau checked and supervised.
5.7	Agencies to establish procedures for identify worker to undertake review of the scheme annually.
5.8	In giving advice workers should take the young person’s lead, and not impose their own views about sexual matters.
5.9	Workers should be aware of how their own behaviour or sexuality may be construed by a young person.
5.10	Where applicable, schemes will develop ways of working in partnership with parents and carers.

6. Staff and Volunteer Training

6.1

That staff and volunteers of participating agencies will have received training covering the following areas:

Evidence of unplanned pregnancy, Sexually Transmitted Infections (STI’s) and HIV in South East London.
Evidence of how condoms prevent unplanned pregnancy, STI’s and HIV.
Effective use of condoms.
Which condoms, which lubricant?
Local sources of free condoms, and other sexual health advice and services.
Fraser guidelines, child protection, the age of consent and confidentiality.
Condoms and equity - working with young people as partners.
Communicating with young people about contraception and sexual health.
Practical ideas, exploring values and ethics.
Promoting condom use: issues for young women and young men, and for young people from different ethnic and faith communities.
Confidentiality. What is it and how does it work in your agency? Why does it matter?
Promoting sexual health - the health benefits of intimacy, pleasure and respect in sexual relationships.

6.2

The training needs of staff and volunteers will be reviewed yearly and up-dates or repeat sessions will be organised accordingly.

6.3

The following resources will be available to partner agencies:

Condom allocation, training and advice on good practice as agreed. (Provided by Southwark Teenage Pregnancy Unit and Health First)
A good practice checklist for all staff and volunteers. (See Appendix 1: Good Practice Guidelines for Condom Distribution to Service Users).
Appropriate and useful leaflets for distribution with condoms. (To be provided by Southwark Teenage Pregnancy Unit or Health First)
One copy of the Toolkit for Effective Health Promotion (DoH2003) which contains sections on condom promotion, a generic section on sexual health promotion with young people, and sections covering work with specific groups)
Follow-up advice and coaching from Health First

7. Confidentiality

7.1

That participating agencies have an agreed confidentiality policy and an agreed confidentiality statement that is visible and accessible to young people. (Section 7.3 is a blue print for a confidentiality statement)

7.2

In order for young people to make informed decisions about contraception and/or condom use, they need clear frameworks and boundaries. In order to seek advice with confidence, they need a clear understanding of what confidentiality is and how it works.

7.3

A confidentiality policy should contain the following assurances:

That anything a young person says will be treated with respect.
That staff and volunteers will not discuss a young person’s personal details without their knowledge.
That their confidential information will only be disclosed in exceptional circumstances, and this would usually be discussed with the young person beforehand.

Exceptions include:

When a young person under eighteen discloses that they are being physically, sexually or emotionally abused, and inaction would put that person at further risk.
When it is disclosed that other young or vulnerable people are being abused or at risk of being abused.
When there is a strong suspicion that the young person may harm others or if under 18 others may harm them.
When a court order is issued to a member of staff to give information.
When what the young person says contains information covered by the Prevention of Terrorism Act 1089, section 18.

8. Distributing Condoms

8.1

That there are clear procedures for staff to follow and that condom provision is planned and monitored

8.2

That, within reason, service users are given a consistent number of condoms per visit. Additional condoms may be supplied in circumstances where there is a clear possibility of unprotected sex.

Participating agencies will vary in the nature of their contact with young people - some will be working with individuals, some with groups. Contact will take place in formal and informal settings. Even so we recommend that general procedures are agreed within teams so that distribution is seen to be fair, consistent and considered.

9. Appendix 1: Good Practice Guidelines for Condom Distribution to Service Users

Good Practice Checklist for Condom Distribution.

Some of the points below are obvious, but it might be useful to keep this checklist list handy just in case.

Are you working within the Fraser guidelines and your Child Protection Policy?
Does the young person understand confidentiality and how it works for your service?
Are there cultural or faith issues, which you need to be aware of? If you’re not sure, ask!
Would it be more helpful for the young person to talk to a male or female member of staff?
Does the young person need support in persuading their sexual partner to use condoms?
Would it be helpful to the young person to talk about their right to make their own choices about sex, contraception and condom use?
Does the young person understand how to use condoms properly? Do you need to explain or demonstrate condom use?
Does the young person understand the importance of using water -based lubricant only?
Does the young person want to know about sexual health services?
Would it be useful for the young person to know about other forms of contraception, particularly emergency contraception?
Is it worth reminding the young person that other forms of contraception do not prevent sexual infections?
Does the young person want to discuss sex, sexuality, and relationships?
Do you have written information that might be useful?
How can you close your contact with the young person in a way that makes it possible for them to come back and ask again?
Is there anything you need to record?
Do you need information, support or training on any issues raised?

Produced by Southwark Teenage Pregnancy and Parenthood Steering Group

Extracts from this document may be reproduced for non-commercial or training purposes on condition that the source is acknowledged

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