Improving access to sexual and reproductive health services
Elana Covshoff is the programme manager for SHRINE, a new mind and body partnership initiative to improve access to sexual health services . In this piece, she writes about what the programme is trying to achieve.
I never thought when I first started volunteering with the sexual and reproductive health (SRH) charity Planned Parenthood in Toronto, Canada at the age of 19 that nearly 15 years later I would be working in London having made a career in sexual health. Working in SRH has always felt like too much fun for it to be considered ‘work’. I now have the privilege of managing a new programme called SHRINE (Sexual and Reproductive Health Rights, Inclusion and Empowerment), where we aim to support people who find it hardest to access services but whose increased vulnerability and health inequalities mean they need our care and support the most.
SHRINE is a recently launched King’s Health Partners programme funded by Guy’s and St Thomas’ Charity. We are an interprofessional team working in collaboration across Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. Our team is comprised of human rights experts, sexual and reproductive health/GUM consultants, addictions, psychiatry and service users.
SHRINE has three main work streams:
Frontline Clincial Services
We offer a full SRH service and our frontline clinical services are delivered to people from three key target groups:
1st year – people who use drugs problematically
2nd year – serious mental illness (SMI)
3rd year – Intellectual disabilities (ID)
The people SHRINE work with do not use traditional services. They often negotiate multiple barriers to accessing mainstream clinics, from the very practical issue of not having enough money for transport to anxiety about being asked about their history with drugs, mental health or involvement with social services.
SHRINE works creatively and flexibly to reach people who often live chaotic lives. We offer an assertive outreach service where a consultant can accompany a health or social care worker on a home visit. We also want to encourage people to come to our clinics so they get familiar with accessing us, but we recognise we need to make this easier. One way in which we do this is by offering a priority access appointment service at Camberwell Sexual Health Clinic, where service users do not have to wait, and get fast tracked to a health care worker.
We are developing a suite of training packages to support health care professionals to address unmet SRH needs for SHRINE’s target groups. We are currently working on a training package called ‘How to Start the Conversation’ to increase staff confidence to provide sexual health promotion.
We also developed a training package for midwives at St Thomas’ Hospital on postnatal contraception. Midwives have been taught consultation skills to discuss all contraceptive methods and the practical clinical skills to provide methods specific to the six week period after birth, such as progestogen only pill, contraceptive implant and injection/depo. A woman under the care of a midwife can discuss family planning and receive her choice method of contraception before leaving the ward. She does not have to worry about making another appointment at a very stressful time addressing a gap in service provision and reducing barriers to accessing contraception.
SHRINE aims to develop a human rights based approach to providing SRH to our target groups. We are investigating the following questions:
- What is a human rights based approach to clinical care?
- How do you operationalise a human rights based approach?
- Is there evidence of a human rights based approach being applied in a SRH context?
- If so, where/how and what was the impact?
- Are there existent frameworks we can pilot with our target groups?
Making an impact
Instead of ending this blog with nameless statistics, I’d like to tell a story of one of the women we have already helped. Jane finds it very hard to leave her flat for anything other than her methadone treatment from her local pharmacy. She regularly misses appointments with her key worker and addictions psychiatrist. A home visit is arranged and Jane agrees for SHRINE to come too because we are “endorsed” by her key worker she trusts. Jane is not using any contraception, but is also not planning on becoming pregnant at the moment. Jane explained that she has not had sex in the last three weeks, and her urine pregnancy test is negative. Dr Rudi tells her about the different contraceptive methods – how they work, that they are instantly reversible on request, insertion and removal process and side effects. She gives consent for an implant and it is inserted during the home visit in her bedroom. Jane is very happy with the care she received and there were no complications.