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Sexual activity under the age of 16 is illegal (Sexual Offences Scotland Act 2009). However between 35-40% of young people have had sexual intercourse before they are 16 and a growing number by the age of 13. The UK has the highest rates of teenage pregnancy in Western Europe and approximately 1 in 10 young people have a sexually transmitted infection. The management of sexually active young people within an Emergency Department setting gives rise to consent, capacity, confidentiality and child protection issues which can present a clinical challenge and feeling of uncertainty among healthcare professionals. There is a need respect the young person’s right to access information and services to safeguard their health whilst equipping staff to deal with this group appropriately.
The purpose of this guidance is to provide clarification of some of these issues and a framework to facilitate a standardised approach to these young people whilst promoting respectful relationships.
Young people under the age of 16 who are engaged in or plan to engage in sexual activity with another person.
This guidance applies to all Emergency Department (ED) healthcare professionals dealing with young people under the age of 16 who are engaged in or plan to engage in sexual activity with another person. It applies to young people irrespective of their gender or sexual orientation. On the basis of current legislation, this guidance does NOT apply to those aged 12 and under ALL of whom require discussion with a senior ED clinician and referral to Social Work services.
All health care professional dealing with this group have a duty of care to ensure the young person’s health and emotional needs are being met AND to assess whether the sexual activity is abusive or exploitative in any way.
The principles of this guidance are those set out by the UN Convention on the Rights of the Child which state:
The young person has a right to seek, consent to and refuse medical treatment provided the health care professional feels the young person is competent to do so. Under the Age of Legal Capacity (Scotland) Act 1991 this requires an assessment by a qualified medical practitioner that the young person understands the proposed treatment and any possible consequences, risks and benefits of that treatment.
Health care professionals should recognise the responsibilities, rights and duties of parents to direct and guide their children
Parents have a right of custody until a child is 16, however this can only be exercised if it promotes the child’s interest.
Parental consent is NOT required before advice is given to a young person who is deemed to be competent but where possible it is preferable for the young person to have parental support and this should be encouraged where it is safe to do so.
Young people under the age of 16 have the same right to confidentiality as adult i.e. personal information should not be disclosed without consent. Any decision surrounding information sharing is therefore dependent on an assessment of current or potential harm (to the young person and/ or others) and not on the basis of age.
With regard to under-age sexual activity, where concerns of harm as a result of the sexual behaviour or relationship exist, the right to confidentiality should be overridden.
Health care professionals must ensure that young people are informed from the outset that confidentiality is not absolute and every reasonable attempt should be made to gain consent before disclosing the information to another party.
The young person should be informed BEFORE they disclose information they wish to be kept confidential of how their personal information may be shared within the team and/ or other agencies.
Where no such child protection concerns exist the confidentiality rights of the young person should be respected.
Any health care professional must be prepared to justify his/ her decision to share information.
Under the Data Protection Act 1998 young people can have access to their medical records subject to a written request for this. Parents are not permitted to see a young person’s health record unless consent is given or the child is deemed too young to understand how to make a request.
Automatic sharing of concerns.
There are certain circumstances where practitioners should automatically share child protection concerns, these include:
Dedicated Consultant Paediatrician for Child Protection:
Via RHC switchboard 0141 201 0000
On-call FP/GUM Consultant:
Via Gartnavel switchboard 0141 211 3000
The Archway, Sandyford Place G3 7NB: 0141 211 8175
Strathclyde Rape Crisis Centre:
PO Box 53, Glasgow G1 1WE: 0141 552 3200
West of Scotland Social Work
Standby 0141 305 6970/ 6910
Sharedcare Helpline (Sexual Health Advisors):
0141 211 8639
Professional Helpline (staffed by specialist sexual health nurses)
0141 211 8646
For children: 0800 11 11
For professionals: 18 Albion Street, Glasgow: 0870 336 2910
This guidance is written with direct reference to:
Last reviewed: 13 December 2013
Next review: 01 December 2016
Author(s): Dr Marie Spiers