Teenage pregnancy prevention: Strengthening local leadership

A spider diagram with the text strategic leadership and accountability written in the centre circle. Of the centre are 10 other circles with the key factors:

• Advice and access to contraception in non-health education and youth settings.
• Consistent messages and service publicity to young people, parents and practitioners.
• Support for parents to discuss relationships and sexual health.
• Targeted prevention for young people at risk.
• Young people friendly contraception and sexual health services and condom schemes.
• Relationships and sex education in schools and colleges.
• Strong use of data for commissioning and monitoring of progress.
• Support for pregnant teenagers and young parents - including prevention of subsequent pregnancies.
• Training on relationships and sexual health for health and non-health professionals.

Barnsley is a market town in South Yorkshire with a population of around 97,000. Since the start of the national teenage pregnancy strategy the council and their health partners have achieved a 66 per cent reduction in the under-18 conception rate.  However, coming out of the pandemic in the summer of 2021, the Children and Young People Public Health Team revisited the Teenage Pregnancy Prevention Framework self-assessment, and relaunched Barnsley’s Teenage Pregnancy Prevention and Supporting Teenage Parents Partnership. 

The need to maintain progress and reduce rates further prompted additional focus as part of the Council Overview and Scrutiny process. A number of elected members formed a task and finish group and identified sexual and reproductive health as an area to explore during 2022/23. Given the wide-ranging nature and complexity of the topic, the group agreed to prioritise attention on teenage conceptions and Long-Acting Reversible Contraception (LARC) following concerns over equity of access across the borough. Over the course of the investigation, the task and finish group met with Barnsley Metropolitan Borough Council (BMBC) officers from Public Health. the Cabinet Support Member for Public Health and Communities, clinical staff from Integrated Sexual Health Services, and a local GP who is also Medical Secretary of the Barnsley Local Medical Committee.

The task and finish group undertook several ‘check and challenge’ sessions with officers and partners regarding the work being carried out, and the current and future and challenges associated with the subject. This involved asking questions of their work and the services available locally.

To support their investigations the group also attended the Barnsley Sexual Health Conference in September 2022 and the Integrated Sexual Health Service open evening in October 2022 where members were given a tour of the facilities and asked questions about access to appointments; safeguarding for staff and service users; access to contraception for young people; and communication methods used to raise the profile of the service.

The group made a total of nine carefully considered recommendations based on their findings. These included specific recommendations to help young people prevent unplanned pregnancy through increasing their access to information and support and to raise the profile and accessibility of LARC and condom distribution c-card schemes; to consider the most appropriate model to support young parents to give their babies the best start in life; and to address the wider determinants of early pregnancy actions to raise aspirations and self-worth in vulnerable young people. 

A key outcome of the review was the reintroduction of the Family Nurse Partnership Programme in Barnsley. In April 2024, after intensive training, a team of one FNP supervisor and three family nurses began providing targeted and personalised support for 75 young mothers and their babies. There has been a high level of engagement and positive feedback from young parents with very encouraging outcomes. Wider benefits of re-introducing FNP includes improved multi-agency working and the cascading of key lessons across the system. For example, the ‘how to’s’ of engaging families who are wary of using services, effective communication and motivational interviewing skills, understanding of the adolescent brain and working with dads. The FNP data system also provides live time data on the needs and outcomes for young parents and their babies and informs the development of Barnsley’s strategy for the first to 1001 days for vulnerable families. 

The Teenage Pregnancy Prevention and Supporting Teenage Parents Partnership continues to meet on a quarterly basis, championing the prevention agenda with an increased focus on RSE, as well as the support needs of young parents.  In June 2025, the partnership is coming together in a planning workshop to review the self-assessment and ensure the local actions identified are still relevant and tangible. Accountability for the Teenage Pregnancy Prevention and Supporting Teenage Parents Partnership falls under the responsibility of the Starting Well partnership group, which consists of strategic partners across Barnsley Metropolitan Borough Council. 

Lessons learned

• The process of the ‘check and challenge’ by the council overview and scrutiny panel provided an opportunity for focused reflection and revised action for the Teenage Pregnancy Partnership.
• This led to the re-implementation of Family Nurse Partnership – which is not only enhancing outcomes for teenage parents and their babies but is enriching wider system learning.
• Whole system engagement and leadership buy in is required to sustain effective local teenage pregnancy partnership working. 

In 2010 the council's drug and alcohol action team designed a social norms survey. Initially in the seven secondary schools, the aim was to challenge the perceptions of young people and reduce their risk-taking behaviour. The initial focus of the survey was on alcohol, drugs and smoking, but quickly extended to cover relationships and sexual health. 

In 2015 the survey moved into the council’s Public Health team where the project was reviewed and updated to include further key topics such as the internet and modern technology, physical activity and eating habits, vaping and mental health. In 2017 the survey was extended again following a pilot delivered in primary schools. The survey has been delivered annually across 32 primary and secondary schools (75 per cent of the schools in the area) with pupils from year 5 to year 11. Annually we receive 5-6000 responses. 

The overall aims of the survey have remained the same over the last 15 years, asking questions about children and young people’s actual health related behaviour at an age and stage appropriate level, then asking about their perceptions in relation to their peers health related behaviours. The key findings from the survey are that ‘most children and young people in the area do not…, vape, drink alcohol and are NOT sexually active’. 

These positive messages are shared far and wide within each school, working with pupils, staff and parents and carers to share the same information and signpost key health information and local services. 

What was done with the information?

Each school that participates in the survey is offered  a meeting to look at the results and to create an action plan based on the findings. This ensures that the curriculum, although following the statutory guidance, is tailored to meet the needs of the pupils in the school. Key preventative and positive messages are shared consistently and integrated into the PSHE lessons and assemblies. This supports the main aims of the survey to decrease risk taking behaviours while improving attitudes to health and wellbeing.

Alongside the work in schools, as a council, they used the combined findings from the survey to inform and support the work we deliver in the local area. These are shared with key stakeholders including the police, rail safety and school nurses who in turn then use the findings  to inform and shape their offer of support to schools.

How was the survey facilitated?

An online data collection tool was used to design and deliver the survey. The lead practitioner for the work is based in Public Health and they work alongside our Data Analyst and with schools to deliver the project annually. Prior to the survey being delivered all parents and carers were notified that this will be taking place and who to contact in school if they have any questions or concerns. 

What impact has this had?

Key outcomes that link directly to the project include reduced teenage pregnancy rates. The survey has enabled the team to work with schools, using their pupil data to create a relevant and personalised plan to shape their RSHE and promote local services. Preventative messages are shared and drop-in services are available within school. 

As the teenage conception rates have decreased, the age of reported first sex has increased and the number of young people engaging in early sex has decreased. The reasons for regret after first sex have also changed over the years, from being related to alcohol to now thinking they were too young and should have delayed sex until they were older. 

Attitudes about relationships are very positive with over 95 per cent of children and young people aware that coercion, control and abuse in a relationship is not acceptable. Pupils acknowledge that contraception is a shared responsibility and have a good understanding of consent. 

Where to from here?

The council will continue to deliver the project, offering all schools in the area the opportunity to participate. In addition, they have worked with our SEN provision to develop a survey relevant for their pupils for the next academic year. The council are aiming to pilot a Further Education version of the survey in the autumn term of 2025. 

Lessons learned

• Administration of the survey can be time consuming but schools and the council benefit from  the wealth and depth of information from the findings to inform RSHE and local messaging.
• Although unexpected, pupils are honest - sometimes  brutally - and have no qualms responding to personal questions and sharing opinions
• Consultation with children and young people as participants is essential, this ensures the content is relevant, up to date, inclusive and delivered at the right level for understanding. It is also a fantastic way to listen to children and young people talk about the survey and their perceptions on risk taking.

The Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement champions the links between health and improved outcomes for children and young people. Developed in 2019 it is based on the concept of proportionate universalism. 

The Council’s approach applies over 40 years of research on social, emotional and health education in schools. Along with school improvement expertise and subject area pedagogy it drives universal preventative practice, interventions and targeted support across the council. This bespoke approach is founded upon sustainable, strengths-based, trauma-informed, relational and restorative life-course practice, and prioritises the wider determinants of health to positively impact and improve generational outcomes for children and young people. 

All Surrey services, partners and state and non-state schools are part of our ‘One System’ ambition to serve the community. This approach assists the County Council to meet Surrey’s Health and Wellbeing Strategy priorities, applying a culture of ‘up-stream’ working to health behaviours, prioritising proactive safeguarding. With clear evidence on the benefits to young people’s relationships, pregnancy and sexual health outcomes, Surrey Healthy Schools is a key part of the Council’s continuing work to reduce unplanned pregnancies.

The approach is led by an experienced education leader with a background in school improvement working directly with an Assistant Director for Education, and public health principal. Close links between Education, Public Health, and a range of services and partners including domestic abuse, sexual and reproductive health, substance misuse, community safety, wellbeing and mental health, physical activity, Surrey Police, the Office of the Police and Crime Commissioner (OPCC), Surrey Fire and Rescue, Surrey Standing Advisory Council on Religious Education (SACRE) along with commissioners and strategy leads, enables effective communication and joined up actions across directorates. Surrey Healthy Schools strategic, operational and governance structures aid additional integration and are supported by both the Director of Education and the Director of Public Health. Membership spans across Surrey County Council, its services, partners, the third sector and includes elected members.

Embedding the approach

Building on a shared way of working, an interactive online Surrey Healthy Schools Self-Evaluation Tool has been developed. This provides a comprehensive framework of standards to assist schools in the co-ordination, development, action planning and improvement of provision, supporting leadership and management, personal development, behaviour, and teaching and learning. The bespoke Tool includes signposting to local services, such as confidential sexual and reproductive health, school nursing (including 1-1 advice for pupils), the support, training and guidance available from Surrey services and partners, and a wide range of more specialist information available from credible national bodies.

A holistic, progressive and developmental training offer enables all primary, secondary and specialist schools to access high quality CPD with a focus upon Personal, Social, Health and Economic (PSHE) Education and related areas. All training is delivered by subject experts from across services and partnerships, including support for secondary schools from the sexual and reproductive health team. 

Working in partnership with the OPCC the council secured Home Office funding to develop a sustainable package of support with a focus upon cohesive communities, helping to mitigate violence against women and girls with a PSHE Leaders and Champions 3-day training, proving to be highly successful . Further to this we have developed PSHE Education Guidance (including Drug Education and Responding to Drug-Related Incidents Guidelines) and the Home Office funding has also enabled the development of a strengths-based and trauma-informed campaign 'Ok To Ask?', to empower secondary aged young people to say ‘no’ if they are under pressure to ask for or send a ‘nude’, and provide support. Due to the campaign’s success alongside the OPCC complementary PSHE Digital Safety resources for KS3, 4 and 5 have been developed.

Impact

The Surrey Healthy Schools Approach Training and the wider PSHE Essentials Training Offer is continuously monitored and evaluated and is shared in the Surrey Healthy Schools Training & Support Report. Findings demonstrate that participants highly rate the relevance of the Surrey Healthy Schools Approach Training and report that it increases professional knowledge, effective leadership, partnership working with local services and improves pupil and staff wellbeing. 

"Surrey Healthy Schools has helped us to see the bigger picture of our school."

"This is an approach which underpins what we do, it is not a bolt on."

"We are doing this to ensure all our children are happy and healthy in all aspects of their lives."

Lessons learned

• Working in this way has aligned the council’s work to reduce teenage pregnancy and improve sexual health outcomes with the wider vision of reducing health inequalities so no one is left behind.
• Maintaining the development of a whole system approach across a large county council poses many challenges but having a bold collective vision has kept the council focused.
• Building a rigorous methodology and culture on the foundations of strong evidence has enabled countless successes and has led to increasingly effective partnership working.
• Skilled leaders and an expert workforce enables the vision to be effectively implemented.
• Clear structures and an alignment of strategy, policy and operational practice have been essential to effectively focus on improving the health and wellbeing of children and young people.

Liverpool residents now have easier access to a range of services, including contraception, thanks to a network of clinics, hubs and pharmacies. 

In 2022, Liverpool City Council and its sexual health service provider Axess embarked on an engagement exercise working with the NHS, voluntary sector and community partners to look at how reproductive and sexual health services could be improved.  

Feedback suggested that people were unsure about how and where to access services and in some parts of the city women reported not being able to get contraception in enough locations. After speaking with young people, there was a clear need for a dedicated young-person friendly integrated offer where full STI screening and contraception needs could be met in one place, with the inclusion of outreach work to universities and colleges.

A further city-wide survey found demand for accessing contraception closer to home as well as online services for both STI kits and contraception. In particular, people reported being put off if they needed to travel too far and did not feel a central specialist clinic was for them. 

Axess 4 U – young people’s offer

The new integrated sexual and reproductive health service was launched in late 2021 and designed to produce a truly integrated system. It consists of the three key integrated sexual health clinics supported by a network of women’s health hubs in each of the eight primary care network areas.

The Axess 4 U young persons clinic was developed and branded with young people, and is a dedicated sexual health clinic for people (aged 19 and younger). This clinic operates as a walk-in, meaning young people can access easily when in need. This combined offer has seen increasing numbers of young people access provision, and locally Liverpool has seen a 10 per cent increase in uptake of Long-Acting Reversible Contraception (LARC) methods in under-25s since 2021.

The offer continues to grow and be well received by young people, with over 2,000 people between the ages of 17-19 using clinics, 9,000 people 18-25 accessing clinics for testing, treatment, contraception and advice, with a further 8,013 reached online (advice around sexual health and online testing access). Additionally, 8,532 condoms were distributed to young people as part of the condom scheme.

The city’s women’s health hubs offer sits alongside Axess sexual health, and offer a range of services from LARCs, such as IUDs, contraceptive implants and injections, through to cervical screening, psychosexual services, ring pessary provision and treatment for menopause and heavy periods. Some of these hubs sit close to student accommodation and have contributed to the significantly increased under-25 LARC uptake rates, a near 10 per cent increase over the last 5 to 6 years.

On top of this, Liverpool has worked with its local pharmacies to develop an enhanced offer around sexual health. There are now 18 pharmacies that are able to offer STI testing and chlamydia treatment, and initiate pill prescriptions for routine contraception. Another 78 pharmacies can provide repeat prescriptions and emergency contraception. 

There is a single point of access for provision via a user-friendly digital front door, where users can book across into the various hubs across the city. These offers are under-pinned by a robust clinical outreach offer to under-served communities and young people. Axess host an award-winning education team who deliver training and advice to professionals, the public and direct to schools and teachers through a relationship and sexual health education (RSE) programme. Interventions include educating and empowering people to know about STIs, symptoms, contraception (inc. effective methods, condoms), how to test, and where to access services. RSE offers also include providing pupils with information about local services, in accordance with the RSE statutory guidance.  Condoms are available at multiple clinics and pharmacy sites across the city (50+ locations), with the option to have them posted via the online service.

Lessons learned

• That continuous improvement and service review are key – review of what is working and how we are reaching young people is vital to effective delivery.
• Voices – listening to young people and their needs has been crucial to developing a robust offer. In this case the brand and clinic name was co-produced, and there are ongoing plans to hold focus groups and insight sessions.
• Mobile outreach to attend colleges, universities and schools has been a key part of the offer, educating and empowering young people to know when to test and understand where services are.
• A solid digital offer wrapped around accessible clinics have proven to be a very successful blended model and allowed multiple ways for young people to access provision.

Barking and Dagenham is an outer London borough with a population of around 220,000. Having been one of the capital’s highest rate areas for under 18 conceptions, the council and their health partners have now achieved a duction of 73 per cent, between 2011 and 2021. This compares to a 20.9 per cent drop in London, which itself saw the largest regional drop in the same period.

The council views service user voice and engagement as integral to the successful delivery of any service, with the condom distribution scheme employing co-design processes through the Young Inspectors programme. The programme is hosted by the Barking & Dagenham Youth Forum, a space which facilitates young people to have a say in issues affecting their lives and communities. Both the Condom Distribution Scheme and the Young Inspectors Programme are funded by public health with some contribution from the Council’s general fund. 

The role of the Young Inspectors programme within the condom distribution scheme is to ‘mystery shop’ different pharmacies which offer the scheme within the borough. They are provided with robust training and to ensure equity, every inspector is paid for each inspection they complete. 

Although running since 2009, there was a renewal of the programme in 2015 to include the condom distribution scheme, which was brought back into the council. The feedback from each inspection enables the Youth Health Programmes Coordinator to have an open dialogue with pharmacies about their performance. This includes providing constructive feedback and areas for improvement, as well as sharing learning across all providers where necessary. 

The feedback is also directly fed into formal training which is provided annually. Additionally, and to increase the scope of the programme, we now have a number of Youth Health Ambassadors who work with a local general practice surgery in the creation of a health hub run by and for young people.

An example of feedback received from different inspections includes:

• “They were excellent, they were so accommodating, and I felt as though my needs were validated, they were constantly smiling and gave me all the information I needed to know.”
• “Although they were lovely this all happened over the counter so I felt like other people in the shop might judge me but other than that they themselves did not judge me and they were so friendly, and I felt safe.”
• “I came during the staff break, there was staff available, but they were unwilling to come during their break. I fully understand the need for a break but how I was told I felt dehumanised, and the staff member almost made me cry, with her extremely rude tone, rolling of eyes and dismissive body language. The issue is not the staff unwillingness to come and help me during their break but rather the principle of the matter, I am still human with the same rights and deserve to be treated as an equal.”

One of the important pieces of feedback received is how the Young Inspectors are treated. Feeling respected makes a big difference while a judgemental look is an instant barrier which may be reported to other young people. In contrast young Inspectors often noted a friendly and welcoming atmosphere, sharing this as a reason they would return to a pharmacy and recommend it to their friends. However, a challenge often identified is being signposted to other pharmacies if not enough staff are available.

The inclusion of Young Inspectors in the Condom Distribution Scheme has allowed for a number of improvements to the service, informed by the intended beneficiaries and most important stakeholders, young people.

Lessons learned

• Lead from the front and by example, always practising what you preach.
• Provide clear, precise, and simple instructions as to how processes should be completed.
• Be flexible, adaptable, and open to change, listening to and taking on ideas for both young people and health professionals.
• Embrace technology, which is applicable and suitable for the location, such as  installing QR codes for young people to sign up to the service in general practice surgeries.
• Offer complementary services which embrace the ‘make every contact count’ (MECC) principles if and when relevant.  For example, raising awareness of the risk of sexually transmitted infections in a consultation about long-acting reversible contraception and ensuring young people are well informed about reliable contraception when they request emergency hormonal contraception.
• Treat young people with respect and trust them to make well informed decisions. 

Walsall ranks number 25 in the most deprived English council, placing it in the top 10 per cent, with many neighbourhoods having multiple aspects of deprivation and inequalities. One in three children are eligible for free school meals and compared with national, regional and statistical neighbours, Walsall has higher rates of persistent and severe school absence, lower average academic progress scores and higher numbers of children in care. 

With all these factors strongly associated with pregnancy before 18, as part of their early intervention prevention work, Walsall Council and NHS Walsall 0-19s service delivers a rolling 16-week evidence based targeted youth development programmes to vulnerable young people aged 13 to 16 years. The programme is funded by the Public Health Grant, ring fenced within the 0-19 budget, and delivered by the dedicated teenage pregnancy team, in collaboration with school nursing, health visiting and schools. 

Young people are invited to join the programme via target schools, social care, early help and looked after children’s teams, with groups of 8-10 meeting in a range of settings. The programme focuses on improving young people’s understanding of healthy positive relationships, negotiating healthy and unhealthy risks whilst linking them to sexual health services, with the overall aim of building confidence, assertiveness and responsibility. As part of the programme (Teens and Toddlers) young people spend time in a local nursery, taking responsibility for mentoring a child in need of extra support. This fosters awareness of the reality of parenting while raising self-esteem and giving young people a positive experience of learning, achievement, and aspiration for their future. They can also achieve NCFE level one qualification in interpersonal skills on completion of the programme.

To assess suitability for the programme professionals complete a Vulnerabilities questionnaire pre- and post- programme and young people complete the Warwick Edinburgh mental wellbeing scale before and after to measure impact. Tracking participants until age 18 provides evidence of the impact along with reports from each programme delivered.

Currently 80 young people participate each year. Over 800 young people have now completed the programme with very positive results:

• 73 per cent of young people who participated in our programme said they felt like a person of worth at the end of it.
• 73 per cent of young people with low self-confidence reported improvements.
• 74 per cent of young people who had been at risk of exclusion are no longer at risk.
• 74 per cent of children and young people with shy and withdrawn behaviour improved by the end of the programme.
• 88 per cent of teachers agreed that the teenagers contact with the toddler had a positive effect on the child they mentored.
• The most recent audit demonstrates 97.3 per cent of all participants have not become parents under the age of 18.
• A recent Healthwatch report validates the positive impact of this intervention. 

In 2023 a local audit identified a particularly high risk of pregnancy among care experienced young people with an increased conception rate at 17 strongly associated with being placed in residential care, having five or more placements since entering care and being placed with a parent/connected or kinship carer. To further target the programme to young people most in need, it is now being offered to Year 9 pupils who are looked after and meet these criteria. Staff delivering Walsall’s Turning Point Service to prevent family breakdown are also now trained to deliver the programme to the young people they are working with. 

Since its introduction in 2010 the intervention has been transformative with attendees learning the importance of planning for the future - understanding the responsibility of becoming a parent and having a job before having a child. The programme has had a significant positive impact on the lives of vulnerable young people in Walsall, improving their self- esteem, academic engagement and life chances, while contributing to reductions in teenage pregnancy and supporting local children in need. 

I was struggling in School as I was misbehaving. Teens and Toddlers helped me a lot, because I’ve become more assertive, learnt many new things and got a qualification. I am confident and happy, doing well at school and home. I’ve learnt how to control my emotions. (Skye, Grace Academy) 

Fantastic initiative that improves self-esteem and aspirations of young people and the children they mentor, improves attendance at school and life chances (Wendi Blews Willenhall E-ACT Academy) 

Lessons learned

• The success of the youth development programme highlights the importance of targeted, early intervention and multi-agency collaboration in addressing complex social issues.
• The programme has been transformative for young people’s lives, but delivering, sustaining and growing this targeted intervention has taken time.
• Building trusted relationships with schools, the Early Help service, looked after children teams and social care is essential for engaging the right young people with the programme
• Having a dedicated champion to lead and bring together partners to pool resources is crucial for sustainability.
• Robust evaluation and evidence of impact supports continued support and success. 

Dudley is a market town in the West Midlands with a population in the Metropolitan Borough of around 312,000. Since the start of the national strategy, Dudley Council, together with their health partners, has achieved a reduction of 65 per cent in the under-18 conception rate. 

Key to this achievement has been targeted interventions that meet young people where they are at, providing them with the opportunity to enhance their understanding of sexual health on their own terms.

Until 2023, Brook provided non-medical outreach services to young people in Dudley as part of the young person’s level 2 clinical sexual health contract. This was funded by Dudley Council’s Children and Young Peoples Public Health as part of the Council’s teenage pregnancy and sexual health programmes.

The service included regular drop-in sessions in all Dudley further education colleges, offering both oen to one advice and group support. This included sign up to the C-card scheme, chlamydia and gonorrhoea testing, HIV and Syphilis point of care testing, emergency hormonal contraception and support with contraceptive choices. Additional outreach to some alternative education provision settings and supported housing venues was also available to engage young people who may be more at risk but wary of accessing services. 

The aim of this outreach was to proactively engage with young people to increase their understanding of how to look after their sexual and reproductive health and give them the knowledge and confidence to access early advice. Reassuring information about local SRH services was key: explaining what they offer, how to access them (online or face to face), confidentiality and the welcoming non-judgmental approach of the staff. 

In 2023 Brook successfully secured the contract to deliver Dudley’s all-age Integrated Sexual Health Service, funded by Dudley Council’s Public Health. The service went live in November 2023, and although no-longer specifically commissioned to provide education outreach, Brook has continued to proactively engage with young people in the spaces they already occupy, both within the community and online. 

Brook delivers weekly spoke clinics for under 25s from two different community spaces. The first is in ROUTES, a young people’s drop-in, located in the Merry Hill shopping centre, while he second is in Here4Youth, a young people’s drug and alcohol, smoking cessation and wellbeing service. The presence of these spoke clinics in popular not only provide young people to opportunistically access STI testing, condoms and contraception, but also helps normalise sexual health services. 

In addition, Brook continues to work in colleges promoting sexual health services and, as part of a subcontract with the What Centre youth partnership, also deliver under 18s health promotion sessions in the community and condom distribution outreach events. 

This face-to-face outreach is also complemented with digital interventions that directly engage young people in the online spaces they occupy. Paid social media campaigns on Instagram are used to target young people in Dudley with bite-size sexual health advice and guidance, as well as links to Brook’s digital front door. There young people can access a range of online services, including STI testing, hormonal contraception, as well as register for the C-card scheme. 

This combination of spoke clinics, face-face outreach, digital engagement and partnership working, has helped protect the positive health outcomes for young people within the new all-age service delivery model. 

Lessons learned

• Protect time and resources for young person specific sexual health provision. While young people may access all age clinics when absolutely necessary, offering protected young people’s sessions in trusted, safe locations enables them to discover sexual health services before they find themselves in crisis.
• Collaborate. Work with key stakeholders ensures that specialist sexual health services are accessible, do not operate in silo and are valued by local communities as a core health and wellbeing resource.
• Combine online and offline engagement. Digital health promotion will encourage take up of online sexual health services among young people, particularly those who are capable of self-managing their care. However, this should still be complemented with face-to-face interventions, particularly for those young people who face barriers to accessing services.

In the London Borough of Islington, the Council’s Public Health funded Health and Wellbeing Team is situated within the School Improvement Service, and provides support and guidance for primary and secondary schools on a range of wellbeing areas, including PSHE (Personal, Social, Health and Economic) education, including Relationships, Sex and Health Education (RSHE). 

The primary PSHE Advisor responded to growing requests from headteachers and PSHE Leads for assistance with parental consultations and building teachers’ confidence to discuss relationships and sex education (RSE) with parents. Discussions had at times been heated and passionate with  some parents having fears about the RSE curriculum content and schools’ intentions. This was often fuelled by misinformation in mainstream and social media. 

To strengthen parent-school partnerships and increase teachers’ confidence, the Council wanted to achieve a space for open discussions. Building on the positive relationship already established between schools and the PSHE advisor, the Council facilitated parent consultation sessions in schools. These discussions highlighted the important shared aim of parents and schools - for children to develop the life skills to be healthy and able to take care of themselves and others.     

Keen to build on this, the Health and Wellbeing Team’s PSHE Advisor has been working with the charity, The Big Think (TBT), since 2021, to offer schools a Community Values Dialogue Project, including CPD opportunities. The Big Think is a Human Values Foundation education charity programme that creates opportunities and spaces for genuine conversations with children and caregivers, with shared values inspiring and uniting communities. 

The partnership with TBT formed because of mutual membership of the Sex Education Forum (SEF) and a shared interest in generating something different, to make a difference to children, teachers and caregivers in Islington. 

The first stage of the project involved meetings with the headteachers of the pilot primary schools who had expressed interest, training for teachers to model the inquiry and discussions with parents, and a consultation with the school community involving online surveys for parents, pupils and staff.

This was followed by a 90-minute RSHE values-led workshop in each pilot school, facilitated by the Council’s PSHE Adviser and TBT for up to 30 participants: pupils, parents, teachers, faith/community leaders and school governors. These sessions addressed the issues parents felt strongly about in the content of teaching and learning and any fears they had; for example, age appropriateness, learning about different families and naming body parts, including ‘private parts’ (genitalia), using correct anatomical words. 

Discussions were facilitated about shared human values, the school values, the respectful relationships and life skills parents were themselves taught in school (or wished they had been), and the results of the survey, including sharing the worries children had expressed. 

The project concluded with a plan for the schools’ communities to work together with the aim of RSHE developing children’s life skills so they can thrive. 

The learning and positive outcomes from the project included:

• Increased engagement of parents from different ethnicities, faiths and cultures and the wider community, and suggestions about lesson content.
• Parents wanting their children to learn about safe, respectful relationships, particularly  online safety, and a realisation that  the skills taught in RSHE were the ones they did want their children to develop.
• Less parental anxiety, with parents feeling included in the schools’ choices for their children and more open to working together - this was particularly helped by positive engagement with influential parents in the local community.
• Greater teacher confidence and parental involvement in these positive discussions. 

As a result of this work, the council will be sustaining the initial engagement and teacher confidence by supporting the pilot schools (alongside other schools) with more workshops, discussions and/or resources; running a second phase with more schools across Islington, including secondary schools; conducting focus groups with parents; and revising their current RSE policy template and FAQs. The learning from the project will feed into RSHE training for teachers and guidance and resources to enrich working with parents and carers for every school. 

Lessons learned

• Engagement with parents and the local community on school RSE has allayed fears, built consensus on shared values and increased parental and teacher confidence.
• In retrospect we would have spent longer determining our evaluation processes and perhaps asked schools to sign a working agreement committing to follow up actions. For example, mentoring another school or producing a case study. However, these are actions we can now take forward.
• The project has been successful in identifying areas to cover during teacher training and will be taking parents’ suggestions forward. For example, a parent asked if there could be lessons addressing being of mixed heritage and we have started to produce materials for schools, to include in out Islington scheme of work, You, Me, PSHE.

From the start of the national teenage pregnancy strategy to 2020 Salford Council together with their health partners achieved a 66 per cent reduction in the under-18 conception rate. However, an increase in the 2021 data prompted the council to consider how to improve young people’s early uptake of contraceptive advice.

Providing easy routes into youth friendly contraception services is an essential component in reducing teenage pregnancy, but access is often challenging for vulnerable young people, with additional factors compounding the problem. Sexual and reproductive health services were finding it difficult to recruit trained nurses, the emergency of the Monkeypox virus has had an impact on service capacity and since the Covid-19 pandemic young people, and practitioners working with them have struggled to access the council’s main sexual and reproductive health services SHINE. 

To address the barriers the council, in partnership with the NHS Integrated Care Board (ICB) locality designated nurse, developed a workforce training proposal to build the resilience of the sexual health services system. The sexual health in the community training programme  was designed to focus on supporting the growing number of vulnerable young people who already face a higher risk of pregnancy but are now experiencing additional challenges of poor mental health and the rising cost of living. Salford has a range of health and non-clinical practitioners engaging with these young people daily and establishing trusted relationships. By improving their skills, knowledge and understanding of the post-pandemic sexual health system, and its limitations, the training aims to ensure these practitioners are clear what they can offer and how they can support young people into clinical services. Aligning to the principle of Making Every Contact Count (MECC) approach, they will also be able to identify any wider needs of the young people and refer them to relevant services. 

The sexual health charity Brook was commissioned to train staff and build a 'train the trainers' resource to equip practitioners with contraception kits and to inform them of where they can access condoms, and importantly, what local services are available from general practice, pharmacies and the 0-19 service, Salford’s school health and health visiting provider.

In September 2023, eleven staff were trained as trainers with the aim of cascading the training to 600 practitioners across Salford. The programme is joint funded from the Salford’s Integrated Care Partnership Innovation and Improvement Fund with match funding from Salford’s Public Health Grant 

Over the period of Oct 2023 to July 2024, twelve 4-hour training sessions were delivered to 149 professionals attended. The feedback and evaluation of the training was completed by 50 per cent of participants with 100 per cent rating the sessions very good or good and agreeing they felt more confident about discussing sexual health and pregnancy with young people. 

In any train the trainers scheme, securing a commitment to cascade the training is always a challenge. Colleagues in the VCSE sector were less likely to become regular trainers, due to job changes and organisational commitments with NHS and council staff delivering most of the training. Five of the eleven initial trainees will continue to deliver a new course which has been revised  to be more localised, relevant to current local service providers and slightly shorter to fit a half day/evening. From April 2025 this is being rolled out on a termly basis.

While it will take time to reach the high target of 600 professionals the reach to professionals working with vulnerable young people was very positive. Notably, staff from two homeless hostels participated in the training, extending its impact to asylum seekers, individuals from deprived backgrounds, and young people from care and residential units, and staff from schools in under 18 conception hotspot areas.

In January 2024, a new provider of sexual health service in Salford started, and new service sites were identified. The new provider employed an outreach sexual health nurse and the referral process for accessing the outreach nurse became the effective pathway which other practitioners can now use to refer vulnerable young people needing timely appointments

As well as building the resilience of the system, the training has strengthened the response to sexual health in Salford. Salford Public Health colleagues launched a new Sexual health Network with opening remarks from the City Mayor and the programme has acted as a catalyst for further development in this area, helping to create wrap-around contraceptive services that support vulnerable young people. The strengthened network of professionals working with young people has had a lasting impact on improving sexual health support across the city.

Lessons learned. 

• The training programme engaged a wide range of professionals across Salford who found it relevant and valuable to their roles in supporting young people.
• The sessions helped identify the wider network of professionals working with young people, highlighting potential areas for collaboration which will foster a more cohesive and accessible support system for young people.
• Administrative support from Salford Safeguarding Children’s Partnership training was invaluable to the small programme team.
• Future sessions could benefit from a more targeted focus to address specific needs of different practitioners.
• Tracking the benefits of the training for young people remains complex. A more effective system to measure outcomes needs to be developed.