Sexually active young people, managing

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Objectives

Sexual activity under the age of 16 is illegal (Sexual Offences Scotland Act 2009). However between 35-40% of young people have had sexual intercourse before they are 16 and a growing number by the age of 13. The UK has the highest rates of teenage pregnancy in Western Europe and approximately 1 in 10 young people have a sexually transmitted infection. The management of sexually active young people within an Emergency Department setting gives rise to consent, capacity, confidentiality and child protection issues which can present a clinical challenge and feeling of uncertainty among healthcare professionals. There is a need respect the young person’s right to access information and services to safeguard their health whilst equipping staff to deal with this group appropriately.

The purpose of this guidance is to provide clarification of some of these issues and a framework to facilitate a standardised approach to these young people whilst promoting respectful relationships.

Scope

Young people under the age of 16 who are engaged in or plan to engage in sexual activity with another person.

Audience

This guidance applies to all Emergency Department (ED) healthcare professionals dealing with young people under the age of 16 who are engaged in or plan to engage in sexual activity with another person. It applies to young people irrespective of their gender or sexual orientation. On the basis of current legislation, this guidance does NOT apply to those aged 12 and under ALL of whom require discussion with a senior ED clinician and referral to Social Work services.

Health Professional Duties

All health care professional dealing with this group have a duty of care to ensure the young person’s health and emotional needs are being met AND to assess whether the sexual activity is abusive or exploitative in any way.

The principles of this guidance are those set out by the UN Convention on the Rights of the Child which state:

  • The best interests of the young person are paramount
  • Young people should be able to voice their opinion. To facilitate this practitioners need to listen and provide a trusting environment which will encourage young people’s participation
  • Health professionals should ensure young people are provided with accurate, age-appropriate information and access to services to enable them to safeguard their sexual health
  • Young people should be protected from harm and sexual abuse. Health professionals have a duty of care to appropriately assess information about the nature and circumstances of any sexual activity that comes to their attention.
  • Harm reduction/ minimisation through education, support, medical care and the promotion of positive self esteem to enable the young person to make informed decisions.
The Young Person’s Rights

The young person has a right to seek, consent to and refuse medical treatment provided the health care professional feels the young person is competent to do so. Under the Age of Legal Capacity (Scotland) Act 1991 this requires an assessment by a qualified medical practitioner that the young person understands the proposed treatment and any possible consequences, risks and benefits of that treatment.

Parental Rights

Health care professionals should recognise the responsibilities, rights and duties of parents to direct and guide their children

Parents have a right of custody until a child is 16, however this can only be exercised if it promotes the child’s interest.

Parental consent is NOT required before advice is given to a young person who is deemed to be competent but where possible it is preferable for the young person to have parental support and this should be encouraged where it is safe to do so.

Confidentiality

Young people under the age of 16 have the same right to confidentiality as adult i.e. personal information should not be disclosed without consent. Any decision surrounding information sharing is therefore dependent on an assessment of current or potential harm (to the young person and/ or others) and not on the basis of age.

With regard to under-age sexual activity, where concerns of harm as a result of the sexual behaviour or relationship exist, the right to confidentiality should be overridden.

Health care professionals must ensure that young people are informed from the outset that confidentiality is not absolute and every reasonable attempt should be made to gain consent before disclosing the information to another party.

The young person should be informed BEFORE they disclose information they wish to be kept confidential of how their personal information may be shared within the team and/ or other agencies.

Where no such child protection concerns exist the confidentiality rights of the young person should be respected.

Any health care professional must be prepared to justify his/ her decision to share information.

Under the Data Protection Act 1998 young people can have access to their medical records subject to a written request for this. Parents are not permitted to see a young person’s health record unless consent is given or the child is deemed too young to understand how to make a request. 

Automatic sharing of concerns.

There are certain circumstances where practitioners should automatically share child protection concerns, these include:

  • If the young person is, or believed to be sexually active and is under 13 years old.
  • If the young person is currently 13 or over but sexual activity took place when they were 12 or under.
  • If there is any indication the young person is involved in pornography or prostitution
  • If the sexual partner is in a position of trust in relation to the young person (note this legislation is applicable to young people up to the age of 18.)
  • If the young person is perceived to be at immediate risk The sexual activity has been non-consensual
Useful phone numbers

Dedicated Consultant Paediatrician for Child Protection: 
Via RHC switchboard 0141 201 0000

On-call FP/GUM Consultant: 
Via Gartnavel switchboard 0141 211 3000

Archway SARC: 
The Archway, Sandyford Place G3 7NB: 0141 211 8175

Strathclyde Rape Crisis Centre: 
PO Box 53, Glasgow G1 1WE: 0141 552 3200

West of Scotland Social Work 
Standby 0141 305 6970/ 6910

Sharedcare Helpline (Sexual Health Advisors): 
0141 211 8639

Professional Helpline (staffed by specialist sexual health nurses) 
0141 211 8646

Childline Scotland: 
For children: 0800 11 11 
For professionals: 18 Albion Street, Glasgow: 0870 336 2910

Editorial Information

Last reviewed: 13 December 2013

Next review: 01 December 2016

Author(s): Dr Marie Spiers