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August 2014 |
drinkanddrugsnews
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Practice exchange |
Family planning
to enable them to become more confident in recognising unmet
sexual/reproductive health needs and to talk in more depth about options.
We opened a subsidiary clinic in another smaller agency run by Blenheim that
is also part of Southwark Treatment and Recovery Partnership. However, we found
that the uptake was low, so this was suspended. All service users from any
drug/alcohol treatment agency in the borough are invited to use the clinic at
SCDAT, so nobody is excluded.
B
oth sides of the professional partnership have learned valuable
lessons from one another and from the service users’ reactions to
the new service. The addiction staff group was originally focused on
contraception, but soon realised the huge benefits to patients of a
full sexual and reproductive health service provision, including STI
screening and treatment, initial management of sexual dysfunction, genital skin
problems, cervical screening, initial management for fertility and menstrual and
bladder problems.
The sexual health staff found how closely addiction staff work with service
users and how fundamental the key worker relationship is to enabling people to
take up healthcare. Simply placing a sexual health clinic in the drug service
would not have worked – the partnership between staff, service users, reception
staff and peer mentors was vital to the project being accepted and used. The
most important factors in overcoming reluctance to attend the clinic were the
expertise of the staff and word of mouth that the treatment was quick, painless
and empathetic.
Working with drug or alcohol dependence provides technical challenges for
clinical staff, which this approach has succeeded in addressing. Firstly, our BBV
nurse who supports the clinic has a local reputation for expert blood taking skills,
so blood tests are done quickly even for people with very poor veins, and everyone
knows they have nothing to fear. This facilitates STI screens and liver tests.
Secondly, liver damage is a relative risk factor that has to be assessed when
providing most prescribed contraceptive methods. Having a consultant-level
clinician available to assess that risk is an efficient way of safely establishing the
options that are available to the woman concerned and confidently helping her to
decide how she wishes to proceed.
The host drug/alcohol service needs a relatively high level of daily visits to
make adequate use of the time of the specialist service providers. Even though
numbers seen in our service have been relatively low each week compared to
mainstream sexual health services, the positive impact is disproportionately high.
Undetected and untreated STIs, incontinence suffered in silence, hidden sexual
dysfunction and worries about cancer are bad enough, but the human and
financial costs of an unplanned pregnancy where a baby will be placed in care
(care proceedings alone cost £25,000 per child) are devastating. We believe that
we have found a way of addressing these issues by providing an in-house
reproductive and sexual health clinic.
We were delighted that the clinic won the 2013 David Bromham Memorial
Award from the Royal College of Obstetricians and Gynaecologists’ faculty of
sexual and reproductive health in recognition of innovative sexual health practice.
We are now looking at developing our approach in other drug services and we are
also considering the implications of what we have learned for people with mental
health problems and for other socially disadvantaged people who may be at risk
of exploitation or unplanned pregnancy with a high risk of repeat removals of
children into the social care system.
Rosie Mundt-Leach is head of nursing for the Addictions Clinical Academic
Group, South London and Maudsley NHS Foundation Trust.
Sexual health staff found how
closely addiction staff work
with service users and how
fundamental the key worker
relationship is to enabling
people to take up healthcare...
h ose