Steve Macabee (00:01)

Welcome back to the P-Pod, the partnership podcast from the Somerset Safeguarding Children Partnership. My name is Steve Macabee I'm the multi-agency training manager for the partnership itself. And I'm really pleased to be joined today by a number of guests in the studio, where we're going to be talking about a really important topic, but one that has a lot of crossover with a lot of different other topics we've been talking today, talking about over the last few episodes. And we're going to be talking about sexual health and the work that Swish the sexual health clinic service in Somerset provides. And importantly, how they kind of work to support children, people, but also navigating some of those, some of those difficult areas, ⁓ like kind of concerns, vulnerabilities, risks and exploitation for children, young people. So thank you very much guys for joining me in the studio today. Can I ask you to introduce yourselves? 

Kassie (00:52)

Hi, so I'm Kassie. I work as part of the targeted outreach team within SWISH as a trainee assistant practitioner.

Marina (01:02)

Hi, I'm Marina and I'm the young person sexual health nurse for Swish.

Kerry Lucas (01:10)

Hi, I'm Kerry. I'm the lead nurse for the target outreach team as well as currently lead nurse for SWISH.

Steve Macabee (01:16)

Brilliant. Thank you, Kerry. as I say, we're going to be talking about SWISH today. Some people may well be very familiar with you. Other people may never have SWISH before. could one of you explain to me sort of what is SWISH and what is the work that you as a team undertake? And I guess how does that sort of fit in with the wider health system within Somerset?

Kerry Lucas (01:37)

So SWISH was established in 2016 when the contraceptive service and the GU service in Somerset integrated together to offer contraception and sexual health countywide. So SWISH stands for Somerset wide integrated sexual health service. So we see anyone for contraception and sexual health from 13 and above. So offering advice, treatments, testing, ongoing long-acting contraception, short-acting emergency contraception, as well as other treatments, be it vaccinations, pre-exposure prophylaxis for HIV, post-exposure prophylaxis for HIV, so lots of things around sexual health.

Steve Macabee (02:27)

Yeah, so not just condoms and pregnancy testing. It's important because actually often we do have quite a narrow view of things, don't we? It's a sexual health clinic. It's that. It's providing lots of condoms for young people and that's about it. But that's certainly not the case in terms of what you do, is it? But I'm just interested to pick up Kerry. So you said in terms of the age range, it's from age 13. I'm just thinking within that, obviously,

Kerry Lucas (02:29)

No.

Steve Macabee (02:56)

the age of statutory rape is below 13. Is that the reason for that age range there?

Kerry Lucas (03:02)

Yeah, mainly and obviously it's advice and information and kind of discussions. It's not sort of just it's preparing people, educating people as well. So it's just being able to act the people to become accessing our service to be comfortable with that service. But obviously some people are having sex under 16. We know through recent research, our counter council colleagues have done that most people wait till they're about 17 to have first sex but it's supporting those that are younger but obviously in line with the law.

Steve Macabee (03:41)

No, thanks for that, Carrie. I'm just thinking in terms of young people who come through your door, are there any kind of particular themes that you see in terms of their needs or are you seeing a kind of change over time? I'm just curious, Marina, I'm just thinking in terms of your role with young people, do you see sort of common themes coming through?

Marina (04:02)

I think really for young people it's ⁓ probably the pressure that they feel they're under with regards to peer pressure or social media and ⁓ with regards to relationships and them trying to navigate what they want from a relationship and what they feel under pressure a relationship should look like.

Steve Macabee (04:30)

And are you seeing, actually I'm curious, Do you see more girls and boys coming through the service or is it a of an equal mix?

Marina (04:39)

I see more girls, but of course we do see boys as well, but the majority of the girls, the contraception.

Steve Macabee (04:48)

And are you seeing those same sort of themes in terms of those pressures that you talked about for both genders or is it mainly for girls?

Marina (04:55)

Yeah, no, I'd say it's for both genders definitely. The boys sort of, you know, under pressure as well from what how they think they should act as, you know, a male or towards a female if it's male and female relationships. So the pressures, I would say is pretty immense for males and females.

Steve Macabee (05:22)

And are you seeing, do you feel in terms of that pressure, is it to have sex earlier or to do certain sexual acts or anything? Is there anything you sort of see coming through? Is it more just that sort of broader pressure?

Marina (05:35)

think it's sort of expectations of each other and what they have and their selves, you know, how they think they should be acting in a relationship, communicating with each other as well as the actual sexual acts. There's sort of obviously things that they're influenced by social media or porn that's more accessible for young people, obviously with the internet. So that... Let's can skew what a healthy relationship is, I feel.

Steve Macabee (06:13)

Yeah. And I was just wondering with that as well from when you were talking. I've lost my train of thought now. I had a really good follow-up question for that. I honestly can't remember what it was now. It's completely gone. No. see, first mess up and it was me, so I can own that one. What was I going to say? I can't remember now. in terms of the rest of you, do you sort of see anything in terms of young people? So those sort of themes or pressures or anything.

Kassie (06:46)

I think a lot of it is pressures from peers and social media. get a lot coming in looking at contraception because they've seen the scary things about depo injections and things on TikTok.

Marina (07:13)

Yeah, they get information from TikTok as well, you know, that the depot is no good. It will make you go blind. I've had some young person worried about, or could cause a brain tumor, which obviously it doesn't. We wouldn't give it if it did. So, their information can be obviously the wrong information.

Steve Macabee (07:38)

And it's that rise in sort of not just online harm, but online use and communication and what have you is huge now and it's growing all the time. And I was just wondering actually on the back of that, have you seen a change at all, I guess, sort going back to the COVID lockdown periods, because there's been sort quite a lot of conversation about the effects that that has had on children, young people in particular. Just picking up from what you're saying, Marina, around sort of social skills and communication and understanding relationships. Have you seen a change in the kind of post-COVID world that we're in now with more online use at all?

Marina (08:17)

I guess it's, was you, obviously they were, the young people were still getting the information pre-COVID, but I think now it's really sort of ⁓ the main source of information that young people go to is the internet ⁓ and influences and TikTok. so I guess that's definitely increased, I would say, since COVID. But yeah.

Steve Macabee (08:50)

I do feel sorry for young people these days, be honest. I think a lot of it is a real challenge between navigating what's factual, what's real, what's influencing and saying whatever works and what is false. What is false news that hits the headlines, gets that good sound bite there and hooks people in, but actually isn't true. I think it's a really difficult situation beyond people trying to navigate all of that in amongst the real world as well.

Marina (09:22)

think it's difficult for adults as well, it? Even not in sexual health just generally it's very difficult. So to be a young person and trying to be safe and get the right information in order to make informed choices it's even harder now than what it ever was.

Steve Macabee (09:42)

Mm. Mm.

No, I think so. I'm with that. And I've worked with young people for many years and I know there are some huge reluctances sometimes for young people to become ⁓ engaged with sexual health services. ⁓ Do you kind of see that? I guess what are some of the biggest challenges that you see for young people accessing SWISH? And how do you kind of work to...

to overcome those. Is there anything particularly that you do, any outreach programs or anything?

Marina (10:16)

Yep, so it's really difficult obviously because we're covering Somerset so that's a really vast area. and obviously young people aren't driving or so they're having to rely on an adult if they live in a village or to access our services. ⁓ But we do have on the website we do have ⁓ the Just Ask part on the SWISH website which they can email in or ask a question on. And that's quite popular from all ages actually. And then we try and work with ⁓ other professionals as well to help them to access our service if that's what they want, know, obviously with their consent. And we're aware of obviously the times if they're in education then we have to make allowances for contacting them after school hours because they can't have their phones in school or anything ⁓ and texting they may prefer text or they may prefer emails because actually having a conversation over the phone can be really difficult for young people because it's not happening on a normal you know they prefer to text or email so

Steve Macabee (11:32)

Mm.

Marina (11:37)

So we're very aware of that.

Steve Macabee (11:40)

Keeping up with the times is, but also I guess with that, you know, it can be embarrassing, you know, and I'm thinking, you know, particularly, I don't know if you've, if you've got an STI or something like that and you've never had anything like that before. And all of a sudden you're talking to not only a stranger, but an adult as well about these things. You can understand how it's a lot less threatening to search on TikTok and have a look on things and take that as kind of the...

Marina (11:41)

trying.

Steve Macabee (12:07)

the fact and if somebody say, don't worry, it'll go away or whatever, you know, it's fine. But then to actually verbalize that to an adult and go, I need to tell you this, this is, this is a bit awkward here. So I guess, yeah, like you say, utilizing those, those say technologies, but you know, there's, there's other methods of communication, I guess, like I say, like sort of text messaging and what have you. I think, yeah, can really work to break down some of those barriers and that, that, that embarrassment, I guess, as part of it. Um, I'm just curious about the, mentioned about the website and the Just Ask. Is that? Um, is that like an FAQ or have you got somebody, you know, sort of live responding to that or AI responses or anything?

Kerry Lucas (12:45)

It's one of the nurses that responds to the questions. So somebody will post a question, then we've had them publish the question and answer on the website or we reply privately. We also have Facebook and Instagram that people can direct message through. So they will have like an automatic, automated response. But then one of the team will reply to them with the answer and have a chat that way. So yeah, there's other different ways

Steve Macabee (12:49)

Right.

Kerry Lucas (13:15)

ways of contacting us and kind of trying to break down those barriers to then accessing the service. So most of our services apart from Millstream at the moment are based in community hospitals or community kind of sites. So you are quite anonymous when you're going there because other people in the waiting room don't know why you're going there and we don't kind of come out and go who's the swish is normally just the first name call. So you could be a

Steve Macabee (13:41)

Yeah.

Kerry Lucas (13:45)

in for anything so yeah and obviously yeah

Steve Macabee (13:49)

Yeah. And are you seeing that being utilized more and more, like with things like Instagram and Facebook and what have you? Are you seeing that really kind of rising popularity or is it staying fairly consistent?

Kerry Lucas (14:00)

fairly consistent I would say, myself and Kassie are normally the replies.

Steve Macabee (14:05)

And obviously we've got this sort of general barriers, I guess, for young people and adults as well, to be fair, I think. do you see anything in particular in terms of any, I don't know, cultural barriers or societal stigmas that prevent young people from accessing your services and support? And is there anything that you target particularly to target particular groups or any particular barriers that you see?

Kassie (14:34)

I do a lot of outreach and we look at like freshers fairs, so we go into the colleges and we do a lot of health promotion and we advertise C-card which is some set free condom scheme for young people up to 19. We go into kind of the YMCAs where they're less likely to want to come and see us so we go and visit them and do kind of testing and contraception and things in their safe space. We go into some of the children looked after homes. Yeah, so we try to kind of make it as easy as possible for anybody that may struggle or have anxiety about coming into the clinic. Then part of our little team will, and we are able to go out and see them where they feel safe and they feel most comfortable.

Steve Macabee (15:32)

Yeah, I think that's really important, it? Quite often we expect young people to come to us as services. Can you hear me now, Kassie? Can everybody else hear me? Yeah? Can you hear me, Kassie? It has gone. Shall I pause it for a second? Brilliant. Well, I think I was quite keen to pick up on themes as well as we've been sort of talking about just now.

And obviously a theme that's been coming up nationally for quite a number of years now, and certainly going back, I'm not pretending this is suddenly when it started happening, but certainly when it sort of really became apparent, ⁓ I guess coming out from the Everyone's Invited website, and then the subsequent Ofsted National Thematic Review into child on child abuse. And Marina, you mentioned sort of about understanding relationships and healthy relationships. I guess how do you kind of approach those conversations where you've got those concerns for young people around sort child on child abuse or not understanding relationships or those challenges within young people's relationships now.

Marina (16:39)

I think we ask everyone, you know, their sexual history, who they've had sex with. And then it's about being curious and sort of asking, you know, ⁓ how they met that person ⁓ and sort of the friendship groups that they're in. So it's having a chat with them really and not making it so sort of like tick box and sort of exploring how they've been in the relationship, how they met them, if their parents have met them and just sort of exploring how they feel, are they comfortable with them, do they feel under pressure from them.

Steve Macabee (17:34)

Mmm.

Marina (17:58)

and exploring their relationship with them. Can they talk to them about sex? I mean, if they can't talk to them about sex, but they're having sex, then that's concerning. ⁓ You know, and how their relationship is being a bit nosy, really.

Steve Macabee (18:12)

And are you seeing that as a theme coming on? Yeah, you talked about sort of that theme of challenges in relationships and pressures and things. And are you seeing that coming through as a fairly regular issue around concerns around child on child abuse?

Marina (18:30)

Well, yes, because I guess it comes from that pressure and it comes from their expectations of their selves and others in a relationship. So then it becomes an abusive sexual relationship without them even knowing it is. Because obviously they're in it and their expectations are not good of their selves and that other person. So it's sort of trying to unpick it really and trying to sort of explore that relationship and what they truly feel comfortable with and not with.

Steve Macabee (19:06)

And are you seeing ⁓ young people coming through where there are concerns around domestic abuse within that teenage relationship? Or is it coming through more around sort sexual pressures or anything like that?

Marina (19:22)

⁓ I think it's relationships generally, whether it becomes physical or not. There's kind of that theme that's... They're trying to navigate what a relationship is, well, a positive relationship is and how they want to be in that relationship. It's probably their first relationship, so they're kind of working it out really, aren't they and obviously all the pressures, the external pressures or even you know the home life pressures ⁓ all plays a part in that.

Steve Macabee (20:04)

And I guess picking up from that theme as well, as you were saying, young people, with it being sometimes often the first relationship they might have had, not necessarily kind of recognizing potential abuse or potential exploitation for them. And we know in terms of child sexual exploitation, often we might talk about things like the boyfriend model where victims don't recognize that they're in an abusive relationship.

I'm just thinking in terms of information sharing for you guys and obviously within the health sector there is quite stringent guidance around the sharing of medical information for individuals. How do you kind of work to balance sort of the safeguarding information sharing guidance with the medical information of individuals, particularly when you've got concerns where there may be exploitation taking place. it is that sometimes I feel from my perspective that that could be quite a tricky thing to navigate sometimes. how do you kind of work in that arena where you've got concerns about a young person, you think actually, like you say, Marina, you're having those conversations, trying to explore that a little bit. And you're thinking, this isn't, this isn't sort of quite sitting right. I haven't got any definitive, ⁓ but this isn't sitting right. How do you kind of navigate that?

Marina (21:27)

Yeah.

We have a really good team within SWISH that we can talk to and air our concerns. Also, we have the Safeguarding Advisory Service, ⁓ which are great. They're always there to pick up the phone or to send an email to. ⁓ So that obviously really helps sort of in-house. then ⁓ depending on what what we're advised, then obviously we follow that up. And it is very tricky. Sometimes it can feel more straightforward if there's a social worker already, or if there's, you know, carers already working with that young person, then we work together and still encourage that young person to access SWISH you know, for their sexual health. But it's really about trying to work together. If they haven't got a social worker in place or a carer, then obviously our safeguarding advisory services is really important to us to guide us for the next steps really. But it's all about communication and talking with the team. And obviously...

Kerry Lucas (22:50)

But I think it's also like you said Marina, you have those conversations with young people and sometimes they're not even aware that their first sexual relationship and you're sort of talking about how is it for them and you're kind of picking it apart with them that sometimes it's them sitting back and realizing that actually it's not healthy and then you're supporting them navigating it that way. And so they're fully involved a lot of the time in that process of sharing information. Obviously we let them know that we're concerned about them and what's happening to them and why we then have to share that information because sometimes until we have those really ⁓ open conversations and all of our young people when they come into the service they're a lot more time to be able to be with that clinician so we are able to have an hour appointment with young people and kind of have those discussions that they might not shared with mum or dad or peers and kind of sitting down and talking about are you happy with that? Does that feel right to you? And kind of can you say no if you wanted to and all of those things that unfortunately lot of the time young people are saying I just let them get on with it because it was easier than kind of stopping them and it's kind of then giving them the strength and the ability next time and obviously talking through that that wasn't right and what they can do to empower them for next time so I think we are as a service really good at holding people and kind of supporting them and kind of giving them those skills as well as then kind of working with other agencies to continue that work. we don't obviously we are bound by confidentiality, but everyone we see we explain if we're worried about you or someone that you talk about, then we do have to share this on. So it's not kind of completely closed off, we never share, we just are able to have those conversations like we talked about sex isn't not everyone's comfortable to talk about so they come in and they really do have a open conversation with us that we can then pick it apart and kind of move forward.

Steve Macabee (25:09)

And on that, we talked about exploitation there, but I think one question that I see coming in to me quite frequently is if you have a young person who you feel maybe vulnerable, but they say, don't want my parents to know this. How is that sort of, do you just sort of honor that regardless or do you say, yeah, what are the sort of balances that you need to, you need to kind of weigh up with those things and where does that line sit in terms of whether you talk to parents?

Kerry Lucas (25:43)

Obviously, yeah, we obviously do the Fraser or Gillett competency with them. So obviously that assessment will then we know whether they're actually able to understand that information and obviously judge whether they we do have to tell their parent because they have don't understand. But then we talk to them about why they don't want to share and obviously the benefits of sharing but also it might be risky. Obviously, some young people live with parents

domestic abuse situation, stuff like that and actually it's safer for not to share but have somebody else outside the family that they can share with or have that support from that clinician to have that kind of regular kind of input from. So as much as possible we support people with it's better to let your mum know we're starting you on this pill or whatever but sometimes it's just not safe to do so and so we kind of treat everyone

Steve Macabee (26:47)

There's a lot of factors to weigh up there. like I say, particularly if you have got concerns about exploitation and you've got somebody saying, but I don't want my parents to know, I don't want anybody else to know. Like I say, it's about navigating all those bits. But, and sometimes it's sort of easier, like say if there is a social work involvement or foster care involvement, then you've got somebody to link in with. But if it's that kind of wider concern.

It's, yeah, numerous factors, I guess, isn't it, to weigh up and like we say about, about, ⁓ competency, talk about GILI competency there and phrasal competency. And, but as part of that is that informed consent, it, to actually understand, you know, what it is they're consenting to. Whereas like we say, in terms of exploitation, sometimes there isn't that understanding that they are actually being exploited. it's, yeah, it must be, it must be tricky sometimes, I think. Go on, do you want to jump in there?

Marina (27:40)

I was just going to say that obviously if we do have concerns about exploitation and they're worried about parents knowing, if that's their main concern then obviously we still report that, we still speak to the young person and explain, know, we can't guarantee mum or dad not finding out but I'm really really worried about you, I need to let somebody know and that's where we go through our safeguarding process of the advice from our safeguarding and also, you know, wherever that may take it to children's social care or, you know, so obviously we don't just hold it, we share that information.

Steve Macabee (28:22)

Thanks very much. I'm just casting back actually, we've recently recorded an episode with Dr. Anna Riddell where we talked about the support and services offered to children and young people who have experienced sexual abuse. I'm just thinking, how does SWISH kind of link in with this work? And I guess that's sort of alongside that the multi-agency safeguarding partners where abuse or neglect is known or suspected. How do you kind of link in with those wider services where a child young person is known to have been abused.

Marina (28:56)

We usually, we refer really, so there's options out there that we can refer into and support the young person in accessing them. So say if a young person has come into us because they've been sexually assaulted, then we work closely with the bridge and then there's other options for counselling as well that they can access. mean, sadly, there is a long waiting list for counselling services. But again, it's not just a matter of saying, here's the number, call it. You know, if they're really struggling, we can call, we have that time with them that we can call the bridge or a counselling service with them in consultation with them. So we can do that first step with them.

Steve Macabee (29:53)

Obviously we talked about age ranges there starting from 13. I'm just thinking, in terms of, if a, a child under 13 had been, sexually assaulted, sexually, sexually abused, would that then sort of fit more under the remit of the bridge rather than yourselves?

Kerry Lucas (30:15)

So if it's sexual assault, then they go to the bridge for forensics and everything, but then they would be referred into the paediatric service for ongoing follow-up care and advice and support, whereas the bridge referring to us for over-13s following sexual assaults. But everyone that comes into our services are asked from the time that they make the appointment, if it's over the telephone, to when they see somebody face to face

Steve Macabee (31:00)

We've talked a lot about the services that you offer and we're always in a constantly evolving world in terms of services and ways of working. We've already talked about those little bit here. I'm just thinking in terms of development of the SWISH service, how do you work to ensure that the voices of children and young people are really feeding in to everything that you do or developmental ideas? Is there anything particular that you do or any sort of groups you engage with?

Kerry Lucas (31:33)

We sub contract to 2BU which is our local LGBTQ plus service in Somerset for young people. So we work closely with them. They help develop and kind of guide us on services for young people that use their service as well as or in our local community. And as well as Marina can talk about the PPI work that she's done.

Marina (32:03)

Yep, so the patient and public involvement is been amazing. So an amazing group of young people at Taunton College campus. They've been involved in  helping us with a poster for SWISH, specifically from a young person's point of view.  So they've managed to complete that and that's going out across the colleges hopefully will be up in display and within their IT systems hopefully come September. and then hopefully with that the aim is to grow it more within SWISH maybe look at the website and maybe you know have the young people come into clinic if they haven't done already and give us feedback. So we're hoping to sort of expand on that a bit more.

Steve Macabee (32:58)

Now that'd be good. Actually getting them in, like you're saying. yeah, young people are often very, very clear about some of their views sometimes. So it's, yeah, it'd be really good to get them in and get them looking around and go, actually, no, you don't want to have that there. Definitely. And I guess the other question that I wanted to ask you today as well, and again, it's a question that comes up for me quite a lot in training sometimes is ⁓ in terms of children with additional needs, with SEND needs, with learning difficulties.

Steve Macabee (33:27)

those vulnerabilities, how do you kind of work to engage with young people with those additional needs and make sure they get the right advice and support? I think as a society, we don't like to think of young people ⁓ with additional needs as being sort of sexual beings. But how do you kind of work to engage with those young people to make sure they get the right support and the right help there?

Kerry Lucas (33:59)

I suppose, well, young people are young people. So we just obviously see everyone as individuals. But we also work in the past, we've done work with Fox's. used to have one of our nurses was the LD link with the team in Somerset. So the LD team in Somerset. ⁓ We, like I say, have extra time. ⁓ We have looked at whether we have particular days and times quiet clinic which we're still looking at whether we can facilitate. I think it's just an awareness when we meet people of what their additional needs are and then normally the same clinician is working in the clinics that they work in each week. So it's building that relationship up. So they see the same person and then it's kind of individual care to them and their needs. And we have on our website, easy read material and links. We've worked with other agencies in Somerset

Steve Macabee (34:49)

Right.

Right.

Kerry Lucas (35:05)

around kind of offering support and advice as well as like Mencap and stuff like that. 

Kassie

Yeah, so we go out and do workshops with small kind of groups of people with kind of learning difficulties, looking at consent, seeing kind of what they know, just creating a safe space for them. And yeah, just going through kind of consent and body parts and what they think it is kind of with touching and Just making sure that there's kind of like an understanding, but working with them to kind of teach them about kind of safety.

Steve Macabee (36:20)

Just picking up on that around the topic of consent. And obviously that's an issue that comes up a lot for young people. Marina, as you mentioned right at the start, there's sort of pressures and around sort of online pressures for young people and societal pressures they had. I think consent is something that comes up a lot. How do you sort of have those conversations? Is there anything you do particularly that's really effective you think, actually, yeah, this is really good way of getting that message across around consent?

Marina (36:56)

I think actually the opportunity of the consultation is really good. you know, when we talk about what's going to happen in the consultation, because obviously a lot of people that come in are nervous, especially if it's their first time. So to explain that, you know, you're in control, you can leave any time  and if you have symptoms then obviously we'll give you the option to be examined, but if you don't want to be examined, you don't have to be. So already sort of laying that down at the beginning and explaining that it's their choice. If they don't want to have a blood test, they don't have to have a blood test. But obviously advising if it's best for them too, it's still their choice. So I think the actual sexual health consultation is a really good sort of

basis for actually bringing consent even into the here and now and then it's a good way then of expanding on that and talking about relationships and sexual relationships Consent, you know Doesn't have to be just sexual it can be is everything it's in every day everything that you do throughout the day.

Steve Macabee (38:21)

Mm.

Marina (38:25)

there should be empowerment to that individual throughout. Yeah.

Steve Macabee (38:29)

So you're modelling that sort of work in the work that you do, those sort of general interactions, you're modelling that consent-based kind of practice there. And Kassie, you're saying you do the outreach work to young people as well. Again, are those sort of conversations that you have as part of that outreach work?

Kassie (38:48)

Yeah, absolutely. I follow the same kind of consultation as we would in clinic anyway. But yeah, we definitely kind of look at kind of whether they felt safe, whether they were happy, whether it was something that they wanted. We do in like workshops, we look at like the traffic light games so they understand and they can kind of put their opinions forward on what they think consent is. And then we kind of like move them around on where consent might lay in each kind of traffic light and what is healthy and what isn't healthy. So yeah, we do work a lot with everyone, not just the young people on any type of consent.

Steve Macabee (39:43)

And I know schools have obviously been doing a lot of work over numerous years now with the revised curriculum and consent coming into that. And do you find that young people these days are generally quite savvy around the topic or do you still feel that there's a lot ⁓ of ⁓ uncertainty around the topic around sexual consent?

Kassie

I do think young people kind of, to an extent they do know, I do think there's still lot of uncertainty. Again, I think it brings in social media when they're looking at kind of things like OnlyFans and stuff and they're looking at porn, I think it can blindside them into thinking that some things that are okay and that is normal and that they like other people doing it, that's normal and that they should just consent to it. 

Kerry Lucas (41:12)

I think it's to say, don't think much has changed. I think that ⁓ it's still ⁓ that non-verbal consent that I think we still get lost in. mean, we as clinicians, sometimes if somebody, if you say, it all right to have your blood taken, they might not say anything, but they give you their arm or something like that. And you still have to check verbally. And I think in relationships sometimes you might say, yes to a certain sex act and then it carries on and people sometimes are unable to verbally say they don't want it to continue like that but the person with them isn't reading that their body is frozen or they're not kind of reacting in that way. They're lost in their own, what they're enjoying and not really having, thinking about the other person. I think that's still happening. I don't think that that's changed much. And some of our work is sort of talking about how the process of certain sex acts or certain things in relationships and were you happy all the way through or did you just kind of go with it because it was easier to do that than say something. And I think porn has got a lot to do with that still. And the porn that we see and kind of obviously there's a movement towards more ethical porn. But I think our young people, how they access porn for the first time at 11 years old and then what they generally that's what they found especially as I think we are as a country the main consumers of porn as well and you see all of these kind of stuff on social media and then those sex acts like choking and things like that are seen as normal and you are weird if you don't want that to happen ⁓ I think that feeds into whether people think they're actually consenting is it because of peer pressure rather than actually what they want.

Steve Macabee (43:22)

Yeah, and I know certainly the research into pornography is very much identifying those themes of that misogyny culture really, isn't it? That sort of dominance of women, say, the choking, the male dominance. And I think that picks up potentially right at the start when you were saying, Marina, in terms of those kind of additional pressures on young people.

I guess feeling like that's what they have to do in order to, yeah, that is what sex is, that is what sexual acts are, and if they're comfortable with it or not. yeah, sort of that's been what they're being told is this is what you need to do, I guess, even if they're not comfortable with it. No, thank you for that. just kind of pull us back to the safeguarding side of things. And obviously, like we say, you work within the health systems and Somerset Foundation Trust, and that being part of the multi-agency partnership arrangements as well. And I'm just thinking, particularly where we've got concerns around exploitation or abuse of children, young people. Have you got any good sort of examples of where SWISH have worked within that multi-agency safeguarding arena to protect your children, young people?

Marina (44:38)

Yeah, I think, you know, we're always working closely with the child exploitation team as well, their workers. And, you know, we have, we communicate well with, about their young people. So, trying to work together to see a young person is something that we do quite often. There's a young person currently who we're desperately trying to, she has access to Swish and she seems comfortable in Swish and happy to come, but her life is quite chaotic at the moment. So we're always trying to adapt and work with the other professional to get that young person access to contraception to at least address unwanted pregnancy but obviously there's lots of other issues going on so it's really important to be working with other professionals that working with that young person and you know that young person really well.

Steve Macabee (45:50)

No, would you say that you had, and you talked about working with children services with the exploitation team then, would you say you had sort of generally good links with other agencies, like with the police for example, if you got concerns or do you think there still some gaps there?

Marina (46:08)

The days of Topaz when we had our meetings seemed very beneficial and that has stopped but they still have the information portal that you can use and they've. Yeah now we have the priorities meetings for the West and East Somerset. That's been something that we've just started to join, hasn't it, Kerry? 

Kerry Lucas (46:51)

We were obviously involved in JTAI as well. that has, I think like Marina said, we've always communicated well for, especially for children that looked after in Somerset of that, but as well as with our colleagues, school nurses and other services that see young people, we've always kind of linked in for the sexual health bit of it. With JTAI last year, which was a year ago,

Steve Macabee (47:19)

Sorry, Kerry just to interrupt, so if anybody's not aware of what JTIA is, it's the Joint Area Inspection that took place last year. It was on the theme of serious youth violence and exploitation where there was an inspection of all of the partnership agencies on that theme. So sorry, Kerry just to jump in, just in case anybody wasn't aware of what that was.

Kerry Lucas (47:34)

Yeah, no. So since that, think that's given us more joint work with Children Looked After, with emergency department staff, with CAMHS, Forensic CAMHS, education, police, so there's more work and development around obviously looking at serious youth violence but then obviously looking at exploited children and obviously sexual health feeds into that so it's definitely much more of god it's improved in Somerset I think there's definitely improving and more communication within all of the services obviously safeguarding and included in that.

Steve Macabee (48:18)

No, thank you for that. I guess sort of building on that just to round us off. If you kind of had that magic wand around sort of anything around improvements, around changes in policy, in terms of change in practice, what would it be from your perspective as a sexual health clinic that you think would really sort of make a difference to safeguarding in sexual health context? Is there anything you think, do you know what, if this came in or if this changed, this would really make the world a difference?

Marina (48:49)

IT systems. Yeah, yeah, not to have so many IT systems. It's, it's, ⁓ you know, it's very difficult because the information's very, ⁓ spread across different IT systems. But I mean, that's the nature of, I suppose, confidentiality and people maybe wouldn't access our service or other services if they felt like everything was going to follow them, you know, throughout their journey in life even and different things they access.

Steve Macabee (49:21)

Hmm. So I guess that's sort of that greater joining up of information sharing and that closer working like say IT systems are obviously these days quite often at the heart of that. And if there's some barriers there that can cause some real gaps. thanks Marina. Kerry, Kassie, any kind of wishlist for you guys?

Kerry Lucas (49:47)

I agree with Marina about IT systems and just communication really, being able to more easily share and hold that person. Sometimes it feels like you've checked one system and it says something and then you check another one and it says something completely different. then you might only have checked the first one and then you have completely different understanding of that young person to something else and then somebody else, you refer them to safeguarding and who obviously checks all of them and gets a completely different picture to what you've got. some, mean that's why the beauty of obviously sharing information when we can and being able to kind of all come together with the information that we've got, that sometimes it just seems like a long process when you've only got a short period of time with that person.

Steve Macabee (50:52)

Great stuff. guys, thank you so much for taking the time out today to come and talk to me about this. I think it's really interesting. It's often an area that people aren't so much aware of. hopefully I'm not talking out of turn here, but I think sometimes sexual health services can be seen as a bit of sort of add-on in the background. But I think, yeah, it's really important for people to understand the really central role that can play sometimes and the crucial role that you have in building that trust, that relationship with children, people, providing them with that support and the really kind of important link that that can make, not just in their relationships, but also, I guess, with other agencies that we've talked about. So thank you for coming in. Really appreciate your time with that. And yeah, great to hear from you. I'm just wondering if anybody wants to find out more about Swish or your website or any resources, where's the best place for them to go?

Kerry Lucas (51:52)

www.swishservices.co.uk

Steve Macabee (51:56)

Perfect. Lovely.

Well, Kerry, Marina, Kassie, thank you so much again for your time. Really appreciate it and take care of yourselves. Bye bye.

Marina (52:04)

Thank you, bye.

Kassie (52:06)

Thank you.