In 1999, North Lincolnshire had the fourth highest teenage pregnancy rate in the UK, so a new approach was needed. Rather than putting the burden of delivering sex education to sniggering teenagers on the shoulders of the teachers, the youth service has built on its existing work via a multi-agency "blanket approach".
The new programme aims to train professionals from different backgrounds to deliver consistent SRE education to teenagers as a team. North Lincolnshire's teenage pregnancy rates have already fallen below the national average, from 56.8 per 1,000 for 15- to 17-year-olds in 1999 to an estimated 46.9 in 2002.
When the Government launched its Teenage Pregnancy Strategy in 1998, the UK had one of the highest teenage pregnancy rates in Europe. It aimed to reduce the number of conceptions by under-18s by 50 per cent by 2010, with an interim reduction of 15 per cent in 2004.
An overall reduction rate of nine per cent has so far been achieved, despite the fact that the latest provisional figures for 2002, which were released at the end of February 2004, have shown little change in conception rates from the previous year. However, these provisional figures do not reflect the whole story - more complete figures are not expected until May.
In North Lincolnshire, a 35-strong sex and relationship education team was put together in 2000 by youth worker Lynnette Smith, made up of members of the youth service, South Humber Health Authority, Connexions personal advisers, school nurses, midwives, health visitors, sexually transmitted infection (STI) nurses, sexual health staff at Choices clinics, and peer educators (see sidebar).
Comprehensive training
Each member of the team has been through a two-day sex and relationship education course, which focused not just on delivering factual information about condoms and sexually transmitted infections, but also on a wide range of issues from grooming, sexuality, date rape, to virginity, abusive relationships and what to do if someone flashes at you.
"As a youth service, we had been delivering SRE education for eight years already and when the money came in from the Teenage Pregnancy Strategy we realised that teachers weren't trained to deliver sex education in schools," says Smith. "We were able to step in until teachers were ready."
The health authority received 22,575 a year for three years for 4,500 young people. Additional funding from the North Lincolnshire Council youth service almost doubled this figure. "It's peanuts," says Smith. "Less than 11 a pupil."
Each team member, no matter what background or profession they come from, delivers the course the same way, with the emphasis being to always take a non-judgmental approach towards young people. While Years 7 and 8 still receive sex education from teachers, Smith's team works as a co-ordinated unit to deliver the sex education course to 14- and 15-year-olds at 14 schools in the area. "We find that the kids don't giggle," says Smith. "They are like sponges and soak up the information and ask loads of questions. They know that whatever they ask will remain confidential and won't be talked about in the staff room afterwards."
Many classes run
More than 600 classes are run in North Lincolnshire during the year. Each school year receives four one-hour classes annually. Around three team members take a class at a time, to enable young people to carry out workshops and ask questions without being embarrassed about their enquiries. Young people are also able to access confidential help from Choices clinics, which offer out-of-school access to sexual health information and advice.
Young men also receive special attention. Bob Hulme, a SRE team member and a young men and young fathers project co-ordinator, says: "As part of the team, I went into schools, exclusion units, and youth offending teams to talk to young men. The myths were amazing. In some cases, internet porn had provided the only information young men had on sex, so they had no idea that most of it was completely false.
"Taking responsibility for fatherhood was an important message to get across as well as the equal responsibility for contraception."
Existing teenage mums were recruited by Smith to become part of the team. Emma Parker, 21, was a troubled teenager who had her son, Connor, at 19. "All we got at school was a video on sex education from a supply teacher, which no-one watched anyway," she explains. "When I was younger I felt there was nothing better for me than to have a baby, but they should teach you how hard it can be," she adds. "I did Lynnette's course when I was pregnant, and have been working with the team for three months. Now I am helping to educate young people. Some don't even know the correct words when talking about a penis or vagina."
The sex and relationship education team was originally set up for largely rural North Lincolnshire, but is currently expanding to cover Northeast Lincolnshire, a predominately urban area, situated around Grimsby. According to workers, a common saying among local young people has been "if you're not pregnant by 17, you're gay".
However, cross-agency working can throw up problems. Michelle Milton, Connexions personal adviser for teenage pregnancy and sexual health, says: "A youth worker would be more challenging towards young people's attitudes towards relationships and raising aspirations that they believe would have a bigger impact on reducing pregnancy levels, while nurses think giving condoms out is the solution."
United approach
Karen Barrass, a school nurse and youth worker working in five schools in the Isle of Axholme in North Lincolnshire, has no issues over following a youth work model. "We all sing from the same hymn sheet regardless of our professional background," she says. "The only problem we have is the length of lessons. Not all schools allow an hour, so sometimes the work gets condensed."
Emma Parker is an enthusiast for the multi-agency, youth work-led approach."Teaching sex education myself now, I can see that it's a lot better not coming from the teacher,"she says. "I didn't even know what a relationship was until I met my partner.
"This model of teaching should be used everywhere."
JOINED-UP WORKING
The sex and relationship education (SRE) team consists of approximately 35 part-time staff, and representatives from seven agencies (see below), including peer educators.
Youth workers - The youth service co-ordinates the multi-agency team
Family planning service - This includes nurses who deliver SRE in their own designated schools and others
Local Centre for Sexual Health - Part of North Lincolnshire Primary Care Trust
Health visitors - Employed by North Lincolnshire Primary Care Trust
Connexions personal advisers - Advisers have undertaken specialist SRE training
Young men and young fathers project - Targets young men in schools
Health care assistants - Employed by South Humber Health Authority
Peer educators - Trained by Peer Education Training
YOUNG PEOPLE'S VOICES
I've had sex education lessons with the team since Year 9 and they taught us what sex was and then built on it by bringing in different things such as talking about relationships and life. It feels like you are talking to a friend rather than a teacher - Katherine Jackson, 15, North Lincolnshire
I have had sex education since the age of 10 and its good to see the same faces come back to the school. It instills trust and it has made me change my attitude towards safe sex and STIs. I prefer the sex education people because it's more confidential and they know more about it - Luke Martindale, 16, North Lincolnshire
I was a troubled teenager with addiction problems and I never knew my dad. I had had foster parents and it was already in my head that I wanted to have kids when I was 15. I had my son Connor when I was 19. I didn't feel loved and I thought that having sex meant you were loved, which isn't right - Emma Parker, 21, Scunthorpe.
