Background/introduction A local needs assessment by Public Health in 2013 identified an unmet need for sexual health services for young people (13–25 years) with learning difficulties. Public Health identified funding and developed a service specification for a local level 2 sexual service that was tendered for a pilot period of 15months. We were successful in bidding for the service.
Aim(s)/objectives We describe our journey in establishing a bespoke sexual health service for people with learning difficulties as part of our level 3 Sexual Health and HIV service. We outline the difficulties we encountered, how we overcame them and highlight learning points for other providers wishing to establish similar services.
Methods A descriptive analysis of the clinic history, service provision, staff training, clinic activity and STI and contraception diagnoses. The complexity of individual cases is captured by brief case histories.
Results The service delivery model is multidisciplinary and was developed in collaboration with all key stakeholders including the users themselves. An initial survey identified a community site co-located with the community paediatric service for disability and a Friday afternoon after school as the preferred options. We advertised the service widely including all schools for children with special education needs, social services and carers and GPs. The service opened in March 2014 as a monthly service (Friday 2–6 pm) and was provided by an experienced dual trained speciality doctor, band 6 nurse and band 2 technician together with the community nurse specialist for children with learning difficulties. The service provided STI/HIV screening and management, a full range of contraception choices and sexual health advice. New patient appointments were 1hr and involved time with both the Dr and nurse in order to meet the complex needs of the patients. After 14 months we relocated the service to our level 3 Sexual Health centre located on the main hospital site due to practical difficulties with providing a remote service to a complex group of patients. We changed the clinic session to a regular weekly session on a Wednesday afternoon (3–6 pm). From March 2014 to Dec 2015 there have been 60 attendances by 18 patients (13F, 5M; 17 heterosexual, 1 MSM; 90% white British). 50% patients were under 25 years with a range from 16 to 40 years. Number of STI screens: GC, chlamydia and HIV = 15; GC and chlamydia only = 10; HIV only = 3. STIs diagnosed: chlamydia = 3, TV = 1, PID = 2, 1st episode HSV = 1. Contraception services provided: implant 3, IUS 1, depo 2, COCP 2, EMC 2, PT 6. Historic child sexual abuse was disclosed by three patients.
Discussion/conclusion We successfully established a dedicated sexual health service for people with learning difficulties. Although numbers of attendances are small the patients present with complex needs and require long appointment times. 38% of our patients were diagnosed with an STI. The service team benefited from additional training in learning difficulties and capacity assessments and support from senior staff in the level 3 clinic.