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��ࡱ�>��	SU����R�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������7 	��[6bjbjUU	L7|7|2K������l��������PPP8��4�� t�pTjjjj>��y { { { { { { $n" �$�� ��jj��� l��jj� lll���j�jy l�y lhl�R�+��] j��(�	t��dPJ"! ] � 0� ? %l%] l�������National Sexual Health & HIV Strategy
Briefing notes for meeting with Patrick French, Gill Frances & SHASTD representatives:
Friday 23rd June 2000, Department of Health: Wellington House, Waterloo

Key areas to investigate and discuss
Improving/prioritising Partner Notification
Developing/improving link work (coordination of sexual health promotion work between outside agencies and sexual health services)
Further development of the �Health Promotion� role of Health Advisers
Developing a Health Advising qualification
Introduction: Health Advising
Health Advisers are an integral part of the Sexual Health Team and of crucial importance in the management of STI�s. The Monks Report as far back as 1988 documents their �central role� in STD control and could only foresee that this would substantially increase as workloads increase. Despite the recommendation that GUM clinics should not operate without a health adviser it is of great concern that 12 years on they are absent from some clinics. It was noted than, and it remains the case today, that no Department of Health guidelines exist for adequate health adviser staffing levels. Concern was also expressed at the absence of a recognised training course in health advising. The Policy Studies Institute (1993) reinforced these findings. The meeting today sets out an agenda which addresses the continuing concerns of SHASTD members about the lack of a coherent national plan to develop their role and responsibilities. It marks the beginning of a formal discussion with the Department of Health on how health advisers can contribute more effectively to a �Sexual Health Strategy�.

What do they do?
 They are an effective network of professionals who liase with each other regarding patients and their contacts.  ie recent syphilis outbreak in North East London.
They co-ordinate partner notification, including provider referral. 
The extended role of the health adviser includes training, schools work, young peoples clinics and outreach, gay men�s clinics, outreach to sex workers, running support groups (e.g for Hepatitis C or Herpes). This work promotes sexual health to appropriate target groups within the community and enables the service to adapt to meet the needs of these groups.
They complete the integrated sexual health service. An integrated service needs to holistically cover related issues such as: - 
Contraception, termination of pregnancy, sexual assault, psychosexual problems, mental health issues, child protection. 
This is achieved either through assessment and referral of individuals or in a coordinating role within the clinic, often involving collaboration with other agencies, such as social services, the police, family planning and other health services.
The Core Areas of Health Advising
HYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm"Partner Notification ��������������������������������������� 
HYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm"Pre and Post testHYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm" counsellingHYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm" for HIV ��������������� 
HYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm"Counselling �������������������������������������������������� 
HYPERLINK "http://www.shastd.org.uk/professional_interest/good.htm"Sexual Health Promotion ���

�
Some Key Issues to discuss
1. Improving & Prioritising Partner Notification

We have resources, reports, literature reviews re contact tracing/partner notification.
Eg. What to cover in a gonorrhoea interview, gonorrhoea partner notification limitations and how to overcome them, standards for audit (GC & CT guidelines)

SHASTD has distributed to members:
Partner Notification Guidelines
Central Audit Group in Genitourinary Medicine. The Clinical Management of Gonorrhoea. (1996)
Guidance on using �contact slips�
Outcome audit tool for gonorrhoea and chlamydia (still being developed)

What needs to be done?
Develop a resource base. ?the internet for this information
Standardise minimum practice in GUM (& non GUM) throughout UK
Improve links re PN between clinics
More work on practice re HIV PN
?have central point to link clients (research and to enable verification) eg for gonorrhoea, chlamydia, & HIV (especially for London � phone and give DOB, name, address and get info back on possible matches)

What will stop us?
SHASTD relies on interested individuals. This work ideally requires funding and time commitment (eg literature search costs, getting to meetings when covering clinic)
Clinics without Health Advisers, or when PN is not a priority. 

What will help us?
Prioritising. Having an action plan
Increased awareness of the importance of getting PN right and promoting the existing good practice.

What can be realistically achieved?
Develop a resource base. ? the internet for this information
Standardise minimum practice in GUM (and non GUM) throughout UK
Improve links re PN between clinics
More work on practice re HIV PN

2. Developing a Health Adviser Qualification
Current situation

SHASTD has long argued for the need for a recognised and unified health adviser qualification.

Health advisers come from a variety of backgrounds - normally they possess an RGN/RMN, CQSW or relevant degree.  Many health advisers have gone on to obtain further qualifications eg MSc courses; diplomas in counselling.

Three courses were set up several years ago in London (NACTU), Sheffield (ENB) and Liverpool (University) for health advisers. The main problem with these was they were very different courses eg the London course focussed mainly on the counselling work, the Sheffield course was more nursing oriented. There was no one recognised qualification at the end of the course, and health advisers did not need to do one of the courses in order to practice.  The London course no longer runs. We are seeking clarification about the other 2 courses but believe they no longer run.

Option 1

5 - 10 day Introductory Course aimed at people new to health advising - really just an overview.

One day How to Become a Health Adviser for those people interested in becoming a health adviser.

Rolling programme eg 10 days a year on various aspects of health advising run throughout the country and HAs would build up CAT points attending these. This could be run by SHASTD

Option 2

Thinking about professionalising health advising and obtaining state registration we would like to aim for a Diploma/MSc in Health Advising. Could we:

a)	add on health adviser specific modules to the MSSVD course in 	STIs/HIV eg health advisers take the 4 original modules and then 	SHASTD runs modules on partner notification; counselling skills; psychological issues; health promotion/prevention; ethics; Young People. We would assess by essays and possible examined role plays/videos?

b)	take parts of Msc in STDs but add a separate module to replace 	core course Basic Science and Laboratory Diagnosis, and add a couple of optional courses then they would come out with an Msc in STDs and Health Advising?

Problems

It is unlikely that we will obtain state registration unless we have a unified training qualification however there are various obstacles.

There are some 350 health advisers in the UK at present so we are a small group. The turnover is relatively small in that health advisers may move clinics but there is not a large intake of people new to health advising each year.

Setting up a qualification course eg one year part-time diploma would be expensive - how would we obtain funding?

Would an academic institution be interested in running a course for such a small group?

If the course was only held in one venue then attendance may be problematic particularly if a course is part time.

The majority of health advisers would have trouble getting funding and study leave for a course.

Cerri Evans met with Graham Carr who lecturers in the School of PAMS at South Bank University and was instrumental in setting up the Liverpool course. He felt it was a huge undertaking to set up a qualification course for health advisers given our small numbers. Graham felt it was unlikely that we could �piggy back� on to exisiting courses.  He suggested that a way forward was to follow BASRT (British Association of Sexual Relationship Therapists) who are affiliated with the BAC. They are a small group (500). SHASTD could set standards, use a portfolio system, recommend courses and allocate CAT points to such courses. Health advisers would then submit their portfolio. We could also look at linking in with modules of the OU.




3. Health advising in the community
(Bethan Moran, Lyndsey Shone, Kath� Jones)

Historically, most Health Advisers are based and work within Genito-Urinary Medicine clinics.  However, times are changing, with an increase in younger clients accessing different sexual health services, eg. Brooks & Family Planning.

Recently, pilot schemes have occurred within a variety of Communities targeting young women, for opportunistic screening and treatment of Chlamydia � the outcome of these schemes have highlighted the major role of health advising.  The flexibility of Health Advisers, nurse issuing and acceptability of non invasive methods of testing will, in future, encourage more opportunistic screening within the Community.

On discussion regarding the role of health advising within the Community, a number of key points were highlighted :-


A Health Adviser working in a Community setting may ideally be based / managed from a Genito-Urinary Medicine setting.  The Health Adviser would aim to promote Genito-Urinary Medicine services, improve the referral system into GU, and bridge the gaps, improving integration and collaboration of services.  Those with complex problems can be referred directly to GU having already made contact and been advised by a Health Adviser.

It is expected that there will be an increase in new patients being seen, tested and treated, especially as Health Advisers working within targeted areas become more familiar with client groups.  Targeted areas need to be manageable, and ideally working with GU from a permanent base, eg. Family Planning setting.  A Health Adviser in the Community may solve some geographical problems where access to a GU clinic is difficult.

Community health advising and GU expertise can offer more time to improve partner notification.  Partners not accessing services can be followed up and encouraged to attend GU services.  Pilot schemes have highlighted that GP�s would welcome the opportunity to refer partner notification on to a Health Adviser.

A Health Adviser in the Community can increase awareness amongst other health professionals.

In summary, health advising in the Community can provide an acceptable package of advice, increased screening � testing, partner notification and in turn may increase referral to GU clinics.  They will also be in a prime position to help with the destigmatising of GU services.

RELEVANT ARTICLES TO COMMUNITY HEALTH ADVISING

Tobin JM, Bateman J, Banks B, Jeffs J.
Clinical audit of  the process of referral to Genitourinary Medicine  of patients found to be chlamydia positive in a Family Planning service. The British Journal of Family Planning.
Rogstad KE, Kinghorn GR, Horton M.
Community control of chlamydia trachomatis. International Journal of STD & AIDS 2000;11:248-249
Thomas M.
Chlamydia testing within Family Planning services:  An audit of compliance with policies.
The British Journal of Family Planning 1997;23:92-95
Kirkwood K, Horn K, Glasier A, Sutherland S, Young H, Parizio C.
Non invasive screening of teenagers for chlamydia trachomatis in a Family Planning setting.
The British Journal of Family Planning 1999;25:11-12
Golden M, Whittington W, Handsfield H, Boyd M, Malinski C, Russel K, Holmes K.
Partner notification for gonorrhoea and chlamydial infection: expansion of services to the private sector and exploited sex partner treatment through a public health partnership with commercial pharmacies. Center for AIDS & STD, University of Washington, Seattle, WA, USA.
Jones K, D�Arcy A, Webb A, Mallinson H, Birley H.
Outreach Health Adviser/Prescriber improves treatment uptake of asymptomatic genital chlamydia infection diagnosed in young women and their partners attending a community based health centre. Dept. GUM, Royal Liverpool University Hospital, Liverpool L7 8XP, PACE, Bootle Health Centre, Liverpool L20 3RL and PHLS North West, Liverpool L9 7AL.
Theobald NJA, Barnes C, McCowan A, Barton SE.
Genital chlamydia infection: a service to assist Primary Care with partner notification.
St Stephen�s Centre, Chelsea & Westminster Healthcare NHS Trust, 369 Fulham Road, London SW10 9NH, UK.
 PAGE 1               Prepared by Chris Faldon, SHASTD Vice President



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