How can we best support young people in clinical settings?

At our recent conference, we dedicated a few hours to the question of how best to support young people in clinics and other health settings: HIV clinics, sexual health clinics, and the real benefit of having peer support workers on hand to help.

We heard from experts, peer supporters, and most importantly from young people themselves on what they would like to see change. With thanks to Jane Ashby, Eli Fitzgerald, Michelle Bockor and all the young people who took part from the Chiva Youth Committee. 

How do we deliver youth-friendly HIV and sexual health services to young people, which make them feel comfortable, listened to, and also take into account their unique circumstances?

This is particularly important seeing as the highest rates of STIs are diagnosed among younger groups, particularly young women aged 15-24. Also, the majority of those growing up with HIV are now getting older and need to access adult services. Attendance rates of these clinics fell sharply during COVID, particularly among younger people. So the question is, how do we reengage young people with these services?

Don’t listen to my HIV, listen to me!

The Chiva Youth Committee have just finished putting together a podcast which partly explores this question and the needs of young people growing up with HIV in these settings. Mental health, wellbeing and other holistic supports were highlighted as being particularly vital. At our conference, they asked medical professionals to put their name to the following promise: “I pledge to ask each young person about their mental health and wellbeing at every single clinic appointment.”

As part of every consultation, they want staff in clinics to:

  • Get to know the young person outside of their HIV
  • Ask the young person how they feeling about their HIV at the moment
  • Tell the young person the truth
  • Don’t judge them
  • Be patient with them

When asked what their ideal appointment would look like, one of the young people shared that they like to see data and numbers. Another said they preferred a time after school, where it was possible to see every specialist without needing to wait around. 

What do young people say about sexual health services?

Jane Ashby from the BASHH Adolescent Special Interest Group, shared how they’ve tried to adapt their sexual health services at the Central and North West London NHS Foundation to encourage more young people to attend. They did a national survey, asking young people to share their experiences of sexual health care appointments during COVID. Two thirds preferred in-person to remote consultations, feeling they were safer, open and more comfortable, but the other third preferred remote appointments. This showed that you really can’t have a one-size-fits-all approach to youth services.

Jane also highlighted that the foremost concern of young people coming into the sexual health clinic is confidentiality. They are also often daunted by the prospect of talking about sex with a stranger. It might be one of the first times they’ve talked about sexuality with anybody, let alone a professional. So it’s good to bear these concerns in mind and address confidentiality from the outset, both verbally and on posters displayed in the waiting area, for example. 

What to do during a sexual health consultation

Beyond confidentiality, Jane highlighted a few other approaches to appointments with young people, including: 

  • Explain why you need to ask personal questions: they’re questions you ask everyone and you need as much information as possible so you can help. 
  • Make sure to see young people alone, at least at some point during the consultation. 
  • Take a trauma-informed approach, saying: if I ask you about something you don’t feel comfortable with, that’s fine, let me know and we can move on. 
  • Ask questions beyond the medical: about home and school life, any concerns about mental health or sexual exploitation/ abuse. Between 5-24% of people have experienced some kind of abuse by the time they reach 18. And young people rarely share this without being asked. 
  • Be conversational and genuinely curious about them as a person. This is not an interrogation.
  • Be sex positive: most people have sex for largely positive reasons, to show love, connect with people and have fun. Healthy sex lives can help peoples’ physical and mental health, so it’s good to also talk to young people about desire, arousal and pleasure. 

Peer support in clinics

We were also lucky enough to have Eli Fitzgerald and Michelle Bockor from Positively UK’s Youth Project talk about their experiences as peer supporters, and what this kind of service can add to a clinic. They described peer support as a relationship where people see each other as equal partners with a focus on mutual learning and growth. Eli and Michelle support young adults living with HIV, as young adults living with HIV. 

Some young adults find it hard to talk about difficult issues with their clinicians but much easier to discuss with someone who’s like them. The peer supporter’s role is to share tips and provide holistic support without judgement. Their presence also supports the young adult to develop better relationships with the rest of the clinicians and nurses on the team. 

This can be particularly important for those growing up with HIV, who may be used to a different clinical experience in paediatric care, and the transition to adult services can be scary. But peer support can help welcome them to the new environment and its ultimate aim is to reduce patients who may be lost to follow up. 

“Their presence is extremely supportive, for both young people attending the clinic, and the multidisciplinary clinic staff.”

-North Middlesex Hospital Youth Clinic on having peer supporters

Peer supporter top tips for working with young people

  • Send a text first: most young people won’t pick up an unknown number, so it’s best to text initially.
  • Try to find common ground: for one person Eli worked with, this was a shared enthusiasm for bubble tea. 
  • Take the time to build trust: young adults are more likely to share how they’re feeling if you create a more friendly, relaxed atmosphere and take the time to develop the relationship. 

Eli and Michelle also support young people outside of clinic hours and offer one-to-one support, group support and various social activities.

Hear more from young people’s experiences in and around clinics in our new podcast, created by the Chiva Youth Committee, due to be released soon. You can also find out more about Positively UK’s youth support services here.