Review of children’s safeguarding services in a sexual health clinic: Should they be seen alone?

Dear Editor,

There has been widespread concern about the impact of the COVID-19 pandemic and associated restrictions on the sexual and mental health of children and young people (YP). The highest levels of both parent-reported and adolescent-reported symptoms of mental health problems were when high levels of restrictions were in place and schools were closed to most children. ¹

It was also identified that there was a disproportionately larger reduction in attendances and accessing of the sexual health services (SHS) of under 18 years (U18) compared with those aged 18 and over during the pandemic. ²

Two prospective yearly reviews were undertaken in our department to evaluate the safeguarding services for YP during the pandemic. Analysis of our practice of all high-risk U18 safeguarding concerns and referral patients was evaluated. We explored if these YP were spoken individually during the consultation or were accompanied by someone else following the child’s request and consent. All safeguarding assessments were consistently carried out face to face in clinic.

The first review was commenced from July 2020 to June 2021, during the peak pandemic restrictions of school closure. A second review was undertaken in May 2022 to April 2023 with partial Covid-19 restrictions in place and schools opened. ³

The results (Table 1) of these reviews demonstrated that consensual presence of another person was found in a significantly high percentage of consultation during both times. This consensual person was mum, friend, family member or a social worker.

Table 1.

Unaccompanied U18 YP compared with accompanied U18 YP during the two periods.

	July 2020 to June 2021	May 2022 to April 2023
Total YP with a concern or referral	62	38
Unaccompanied YP	37 (59%)	20 (52%)
Accompanied YP	25 (41%)	18 (48%)

This was the first review of this kind which demonstrated that some young people prefer their named support to be present during the consultation rather than being seeing alone.

A confidentiality policy is discussed with all YP who attend sexual health services at the beginning of their consultation. ⁴ Although confidentiality is paramount in SHS, the results showed that the personal preferential option for some YP may have changed during the challenging times. It is likely that some safeguarding issues may remain undisclosed ⁵ in clinic during the presence of others during the consultation.

There is little published evidence on how YP would like to access sexual health services. ⁶ However, consideration and further evaluation is needed in supporting the YP who request the presence of a trustworthy person of their choice to care for YP with emotion. Educating these accompanied persons, whom the child feels can assist them may benefit the YP.

The presence of this dependable and reliable person may be essential and deemed necessary for safeguarding a significant proportion of YP in promoting their psychological, sexual, and reproductive health in this challenging post pandemic time.