Scottish Government

Appendix 1

This appendix provides more detail on the methodology used and contains the study tools.

Methodology

Key approaches

Tools referred to in the following sections, for example interview schedules or guides for observation, are also contained later in this appendix.

• Desk based analysis of key documentation: This has included material from Caledonia Youth and from commissioning agencies which includes updates on progress with 'Respect and Responsibility' nationally, and the results of the recent Scottish Government Stock Take review. NHS Quality Improvement Standards for Sexual Health Services and Key Clinical Indicators for sexual health have also been discussed. The Sexual Health and Wellbeing Network has also produced much useful information, including recent Evidence Reviews focusing on Black and Minority Ethnic young people, and young people with a learning disability ( TASC were involved in both processes). Healthy Respect (with its partners including Caledonia Youth) has also produced useful materials; including the development of standards for sexual health clinics which TASC knows well. The publication of Douglas Kirby's substantial findings on effectiveness of programmes to reduce teenage pregnancy and STIs have proved to be very helpful.
• Individual interviews and group discussion with CY staff and Board:CY staff were brought together as a national team to reflect on stated aims and objectives of the agency and as Branch teams to reflect on more local issues in development and delivery of services. In order to capture individual views staff were interviewed face to face, 21 of a full team of 27 staff were engaged individually, with a self-completion survey (posing the same questions) given to the remaining 6 staff of which 2 were returned.
• Individual interviews with external stakeholders: Scottish Government, NHS Health Scotland and Caledonia Youth as members of the review steering group worked together to identify 75 stakeholders from across agencies with a knowledge of Caledonia Youth's work. 51 of these stakeholders responded to the invitation and contributed to the review via a semi structured interview: 21 were interviewed face to face, 24 were interviewed on the telephone and 6 completed a self-completion survey posing the same interview questions.
• Observation of education practice and group discussion with young people: As facilitators of the review we were keen to see education work in both formal and informal settings and with young people of different backgrounds and with different abilities. In discussion with Education staff at CY the TASC team identified a number of possible groups currently engaged in education programmes facilitated or co-facilitated by CY staff which could be observed in delivery, and which would then provide a group which TASC staff could interview. 5 groups were selected. The purpose of the observation and group discussion was described to host settings and in turn to young people and their consent sought to engage. Information leaflets for young people were provided. Whilst a guide to what was being observed was designed by the TASC team and shared with group facilitators in advance no notes were taken whilst observing practice so that there was no intrusion on what was taking place; this meant that the TASC observer completed notes after the session. In terms of discussion with the young people questions were posed on a large prop so that young people could see the question/prompt written down and could also see what the facilitator was writing down. 5 groups were observed and then engaged in discussion, this involved 30 young people.
• Observation of clinical practice: When young people arrive at a CY clinic they register with the receptionist and give some indication of the purpose of their visit. Clinic nurses then collect notes and the young person and take them to a consultation room. At clinic sessions where TASC review team members were present clinic nurses were briefed to ask young people if they would consent to a member of the review team sitting in, information leaflets about the review were provided. Emphasis was placed on the fact that the observer was interested in the practice of the professional, not the personal details of the young person. The agency often has new colleagues, students on placement or external professionals making such requests and is practiced at assessing whether or not a young person should be asked, so for example a young person who is very anxious or upset would not be asked to participate. Where young people consented to an observer the TASC team member sat as unobtrusively as possible in the consulting space. While a guide for observation was developed no notes were taken during the consultation, but completed afterwards. The observer also had the opportunity to ask questions of the clinic nurse after every observation. 14 individual consultations were observed across 3 Clinic sessions (2 in Edinburgh and 1 in Tullibody).
• Individual interviews with young people using clinical services:TASC review team members attended clinics in Falkirk, Tullibody and Edinburgh to undertake individual interviews. At the end of clinic consultations clinic nurses asked young people if they would be interested in meeting a member of the TASC review team, information leaflets about the review were provided, emphasis was placed on the fact that the observer was interested in the practice of the agency, not the personal details of the young person. 34 young people using clinical services gave their consent to be interviewed and were shown to a separate meeting space where this could be done privately. The interview questions were posed on a series of A3 size sheets so that the young person could see what was being asked and could see what the interviewer was recording, assuring accuracy but also that nothing was being recorded about the young person's personal details/circumstances. Interviews took between 20 and 40 minutes.
• Self completion questionnaire for young people using clinical services: To capture views from a larger number of young people a self completion questionnaire was designed. Taking on board the experience of CY that young people, once they have finished in their consultation, do not tend to give time to surveys, it was decided to only ask young people who had used the service at least on one prior occasion to complete the survey so that this could be done while young people were waiting to be seen. 254 young people attending clinics in Edinburgh, Falkirk and Tullibody completed the survey over a period of 3 weeks. Due to the demands made on reception staff in a busy clinic it was decided not to add the additional task of recording numbers of young people who were asked but who declined to take part, nor were reception staff asked to record numbers of young people who they decided may be too anxious or upset (prior to seeing clinic staff) to be asked to complete the questionnaire.

Timeline

The project was commissioned late April 2008 with an inception meeting early May 2008. First drafts of the report were shared in December 2008. Drafting of the main report, the detailed appendices document, the Research Findings document continued through January with final drafts agreed in February 2009. The timeline for the key elements of the Review work were as follows

Enhanced disclosure

The TASC Agency is a registered body with Disclosure Scotland. All members of the team have Enhanced Disclosures.

Ethics and codes of practice

While Research Ethics approval was not required for the service review ethical practice remains important to our practice. The work of Richard Pring ¹ informs our consideration. Pring discusses some of the 'rules' which the researcher might be expected to follow - for example this might mean working within procedures adopted by a host setting about the protection of vulnerable children or adults. Pring also suggests that in social research the major debates are often about the principles of respect for the researched (or what he calls a 'democratic' style), and truth-telling. Pring writes of the disposition to act appropriately, of the moral and intellectual virtue of the researcher; moral virtues being concerned with things like kindness or honesty, intellectual virtues concerned with truth, openness and clarity. We work in ways which put this thinking into practice. TASC staff are members of the Social Research Association and follow the SRA code of practice for social research.

Consent

Connected to discussion and consideration of the need for ethical research is the need to consider issues of consent. TASC work often involves a mix of professionals and service users and so consent is an issue of interest to us. Our working definition of consent might be defined simply as an individual's voluntary agreement to another's proposition, however consent is also informed by the person's ability to consent and so we need to consider: Do they understand what they are consenting to? Do they have the information they need? Is there anything about the relationship which already exists which might unduly influence the giving or withholding of consent? Consideration of these questions takes us to a definition which is particularly relevant in the context of conducting research/evaluation/review where consent might be defined as: ' The voluntary agreement of a person or group to participate in research. This should be obtained in conjunction with the person or group being given adequate information which has to be fully understood by the subjects; hence 'informed consent' ².

A typical response to the question about informed consent has been to produce information leaflets for people who might be subject of an intervention by a professional person, be that for treatment or research. However this may not be enough because we also need to consider that we are ensuring an understanding of voluntarism, the right to withdraw at any time and an awareness of the impact that participation may have.

To summarise TASC's practice we would always seek consent from those participating, initially and at later stages of the process. This would mean producing written information about the purpose of the research, what we will discuss, how we will do it and clarity about it being okay to say no to participation at any stage by checking continued consent verbally.

In terms of consent from the young people in this study we chose not to seek written consent as we feel this can make young people with poor literacy, and young people who do not want to see their names and signatures collected, feel apprehensive about participation. Young people can feel threatened by what is essentially a contract. We understand that such an approach means checking understanding and agreement throughout the process of engagement.

Data protection, confidentiality and anonymity

We have offered anonymity to all participants. This means that as data is recorded and written up it is anonymised. Participants are given a dedicated file name and all information from them stored as such, under their dedicated code and not under their name. No information has been used in the report which has not been checked to ensure that the individual cannot be identified. External stakeholders were informed on engagement that they would listed as contributors in an appendix.

Equality issues

In terms of engagement with contributors we are always mindful of diversity of experience, background and needs. Our approach ensures that we make no assumptions about participants, nor do we design interviews or group processes which by their design or content make assumptions about people. In considering engagement with staff and service users we state in written and again in any verbal contact that we are happy to adapt any of the approaches to meet the communication or access needs of the individual. We were also keen in the context of the review to ensure that we hear the lone or dissenting voice; with a commitment made to representing all views appropriately and proportionately.

Dissemination

We have agreed to support dissemination of the research findings; it is our normal practice to actively engage with commissioning bodies in such aspects of the work. A summary report has been written for young people which Caledonia Youth will make available in waiting rooms and on line.

Reimbursing participants

We normally reimburse non-professional research participants in two ways. Firstly any costs associated with participation for example transport costs, costs associated with any additional support needs are met. Secondly in terms of young people/service users, for those attending individual interviews and group discussions we have given a £10 HMV voucher as a thank you for their contribution.

Comparison with external evidence

In relation to developing the approach and the tools for the Review the team drew on the analysis undertaken by NHS Health Scotland ³ and the extensive work undertaken by Douglas Kirby and team for The National Campaign to Prevent Teen and Unplanned Pregnancy in the United States ⁴. This emerging evidence suggests that strategies to address poor sexual health outcomes should have a multi-faceted approach which includes Education and Clinical/Counselling services. The characteristics these services should have are described and have helped the Review to reflect on those services provided by Caledonia Youth. In addition to descriptions of service strands evidence also suggests that a multi-faceted approach should address the wider influences in young people's lives (such as social environment or self esteem); it should also explore the extent to which services address and impact on aspects of sexual health and wellbeing (such as sexual knowledge or behaviour); and whether services/programmes are engaging with specific populations vulnerable to poorer sexual health (such as young offenders or young people who have a learning disability/difficulty). It was not the intention of the Review to suggest that Caledonia Youth's work must reflect all such aspects or characteristics but to use the evidence base as an aid to exploring and describing what is done, what views are held about this work, and as a source of guidance on what might be possible.

Use of quotes

Quotes from study participants are used throughout the main report and in appendices. Anonymity for contributors was agreed. Where the quotes are from a member of Caledonia Youth staff team of Board they are identified as ( CY). Where they are from an external stakeholder they are identified as (S). Where they are from a young person they are identified as ( YP). In young people quotes gender and age are provided; the young person identified as (M15) is male, aged 15.

Study tools

The following study tools are included in this appendix:

• Information sheet for young people
• Information sheet for staff
• Information sheet for external stakeholders
• Caledonia Youth staff interview schedule
• External Stakeholder interview schedule
• Young peoples clinic questionnaire
• Young peoples clinic interview schedule
• Clinic observation guide
• Education session focus group guide
• Education session observation guide

A Review of Caledonia Youth

This is an invitation for young people to have their say about Caledonia Youth

What the review is about

We've been asked to find out the opinions of young people who are in contact with Caledonia Youth. Maybe you come along to a Caledonia Youth clinic, or maybe you have met a Caledonia Youth worker somewhere else, like in your school or youth club.

What we'd like to talk about

In a friendly way we'd like to find out what you think about the service you get from Caledonia Youth. We'd like you to tell us what staff do to help you when it comes to sexual health and relationships. You can also tell us anything about what you would like to change or improve about Caledonia Youth.

What are we asking you to do?

We'd like to meet with some young people individually and do an interview. We would also like to meet with some young people in a group, if that's how they met with the Caledonia Youth worker. There will also be some quick questionnaires for lots of people to do.

If you do an individual interview it will take about 15 to 20 minutes. If you come to a group it might take a bit longer. We don't ask anything silly or embarrassing; just some pretty straightforward questions about what it's like to use Caledonia Youth. Whatever you tell us we'll write down on a poster we'll bring, one for each interview or group. You will be able to see what we write down.

What we'll do with what you tell us

Your name won't be used in the report we do, all your details will be kept confidential. After interviewing lots of young people who know Caledonia Youth, as well as workers too, we will be reporting to the Scottish Government about Caledonia Youth. We will suggest some things about the future of Caledonia Youth.

To say thanks

If you take part in an individual interview or group, to say thanks for your time we will give you a £10 voucher. We will write a report for young people. This will be ready in November. We will put it on the Caledonia Youth web site and leave copies in Caledonia Youth waiting rooms. If you don't see one you can also ask a member of staff to see it.

Who are we?

We are called TASC. We are an independent agency who do a lot of work about the health and wellbeing of young people. If you have any questions before we meet please do get in touch, we're happy to talk to you.

Colin Morrison or Cathy McCulloch

Telephone: 0131 555 3527

Email: colin@tascagency.eclipse.co.uk

We are doing this work for the Scottish Government who provide funding for the work Caledonia Youth does.

Information for staff

The External Review has been commissioned by The Scottish Government and will be conducted by independent research agency The TASC Agency. You may have already met TASC staff who will facilitate the Review; they are Colin Morrison, Daniel Clapton and Cathy McCulloch.

Why is the Review being done?

There is an increasing body of data which helps us to understand sexual health and sexual behaviour in Scotland today. In particular it is clear, as the agency Caledonia Youth knows well, that in Scotland it is young people, in particular young people from the most deprived communities, or those who may have difficulty accessing information, education or services, who have poorer health outcomes.

The purpose of this work is to review Caledonia Youth's contribution to promoting sexual health and wellbeing in relation to the funding made available by the Scottish Government. The Review is not a review of you or how you perform individually in your job.

What will the Review look at?

Specifically the Review will:

• Evaluate the effectiveness of Caledonia Youth in delivering its own key aims and objectives.
• Examine the extent to which Caledonia Youth provision reflects what the current evidence recommends in relation to a multi faceted approach to effective education, information and clinical services (including contraceptive services).
• Assess Caledonia Youth's short and long term strategic planning process.
• Assess Caledonia Youth's contribution to developing and delivering national sexual health policy, namely 'Respect and Responsibility'.
• Identify key strengths which can be built upon and propose solutions to any weaknesses which need to be addressed.
• Make recommendations on the future direction of Caledonia Youth.

How will it be done?

Over the coming months - ending with a report in November - TASC staff will be meeting with Caledonia Youth staff and management, with young people who access Caledonia Youth services, and with other external professional people to gather views and make recommendations which reflect the purposes of the Review as outlined above.

Caledonia Youth staff will be able to participate individually and in their teams; both face to face and on line. In advance of meetings information will be provide about the purpose of our contact with you.

We understand that Caledonia Youth staff are already busy, and that accommodating our requests for your participation, or access to the young people you work with, is an addition to your workload. We will do our best to work around your availability and existing commitments.

We also understand that the process of Review in itself can lead to some feeling of anxiety. In recognition of this we will do our best to be transparent in what we do and to listen carefully to how Caledonia Youth colleagues describe their work.

Contributions from staff will be managed sensitively. Where specific contributions are reported, for example in an illustrative quote which helps us understand an issue or point raised by a staff member, the contribution will be anonimised. We are happy to clarify this before and during the interviews and discussion we will have in the coming months.

What about feedback and questions I may have?

We will feedback regularly on the work we are doing, and share draft findings and recommendations as they emerge. At all times a member of the TASC team will be available if you have any questions. Please direct any questions or requests for further information to:

Colin Morrison
Tel: 0131 5553527
Email: colin@tascagency.eclipse.co.uk

Who are TASC?

TASC is an independent agency with an interest in the health and wellbeing of children and young people, particularly those who we might perceive as vulnerable, and who have some of the poorest health outcomes. Some of our other work includes:

• Lead researcher Colin Morrison was a member of the Scottish Executive team which produced the report 'For Scotland's Children' at:

www.scotland.gov.uk/library3/education/fcsr-00.asp

• The Fife Regeneration, Health and Wellbeing Study adopts a participative community based model which seeks to influence and change services at: www.healthyhappyfife.org

• A new study for LGBT Youth Scotland commissioned by Scottish Government, called 'Our Journey' explored the interface between service responses to the needs of lesbian, gay, bisexual and transgender young people and child protection policy and practice. Available via links at: www.lgbtyouth.org.uk/news/launch-of-research-report-our-journey.htm

• We conducted a national audit for NHS Health Scotland looking at confidentiality and sexual health services for 13 to 15 year olds. We were also involved in work for NHS Health Scotland on gathering the views of young people with a learning disability and young people from Black/Minority Ethnic communities on sexual health services.

These studies have sought to capture the experiences of individuals and families and the service providers with whom they engage; and then in turn present findings as useful, and sometimes challenging, data which can impact positively on policy and practice.

An External Review has been commissioned by The Scottish Government and will be conducted by independent research agency The TASC Agency. TASC staff who will facilitate the Review are: Colin Morrison, Daniel Clapton and Cathy McCulloch.

Why is the Review being done?

There is an increasing body of data which helps us to understand sexual health and sexual behaviour in Scotland today. In particular it is clear that in Scotland it is young people, in particular young people from the most deprived communities, or those who may have difficulty accessing information, education or services, who have poorer health outcomes.

The purpose of this work is to Review Caledonia Youth's contribution to promoting sexual health and wellbeing in relation to the funding made available by the Scottish Government.

How will the Review be conducted?

Over the coming months, ending with a report in November, the team at TASC will be meeting with Caledonia Youth staff and management, with young people who access Caledonia Youth services, and with other external professional people like you to gather views and make recommendations about the future direction of Caledonia Youth.

You have been identified by members of the Review Advisory Group - either Scottish Government or Caledonia Youth representatives - as a key stakeholder who can offer a view on areas of interest to the Review. You may not be able to reflect on all of our objectives, but we are sure you will be able to offer a valuable contribution dependent on your relationship and knowledge of Caledonia Youth's work.

External stakeholders like you are being asked to take part in a face to face interview, or a telephone interview, or a survey. In advance of interviews information will be provided about the purpose of our contact with you.

Contributions from external stakeholders will be managed sensitively. Where specific contributions are reported, for example in an illustrative quote which helps us understand an issue or point raised by an interviewee, the contribution will state the interviewees given random interview number and sector where the contributor is located (for example Health, Education) but will otherwise be anonymised. Where we feel that a specific issue or point is being made which does not make anonymity possible we will seek permission from the interviewee to use the contribution. All contributors will be listed alphabetically (by name and post held) in an appendix to the report. We are happy to clarify any aspect of management of contributions before and during the interviews we will have in the coming months.

What will the Review look at?

Specifically the Review will:

• Evaluate the effectiveness of Caledonia Youth in delivering its own key aims and objectives.
• Examine the extent to which Caledonia Youth provision reflects what the current evidence recommends in relation to a multi faceted approach to effective education, information and clinical services (including contraceptive services).
• Assess Caledonia Youth's short and long term strategic planning process.
• •Assess Caledonia Youth's contribution to developing and delivering national sexual health policy, namely 'Respect and Responsibility'.
• Identify key strengths which can be built upon and propose solutions to any weaknesses which need to be addressed.
• Make recommendations on the future direction of Caledonia Youth.

What about feedback and questions I may have?

We will feedback regularly on the work we are doing to the Review Advisory Group. On completion of the Review a link will be sent to you giving access the Review Report. At all times a member of the TASC team will be available if you have any questions.

Who are TASC?

TASC is an independent agency with an interest in the health and wellbeing of children and young people, particularly those who we might perceive as vulnerable, and who have some of the poorest health outcomes. Some of our other work includes:

• Lead researcher Colin Morrison was a member of the Scottish Executive team which produced the report - 'For Scotland's Children' at: www.scotland.gov.uk/library3/education/fcsr-00.asp
• The Fife Regeneration, Health and Wellbeing Study adopts a participative community based model which seeks to influence and change services at: www.healthyhappyfife.org
• A new study for LGBT Youth Scotland commissioned by Scottish Government, called 'Our Journey' explored the interface between service responses to the needs of LGBT young people and child protection policy and practice. Available via links at: www.lgbtyouth.org.uk/news/launch-of-research-report-our-journey.htm
• We conducted a national audit for NHS Health Scotland looking at confidentiality and sexual health services for 13 to 15 year olds. We were also involved in work for NHS Health Scotland on gathering the views of young people with a learning disability and young people from Black/Minority Ethnic communities on sexual health services.

What's next?

We will make contact with you shortly with a request for your involvement. You may also be able to identify further colleagues who you think would have something to offer the Review. In the meantime, please do direct any questions or requests for further information to:

Colin Morrison Tel: 0131 5553527 Email: colin@tascagency.eclipse.co.uk

Staff Interview Schedule

Individual interviews with Caledonia Youth staff

The interview outlined here will structure interviews with staff. Up to 20 staff members will be interviewed; those not interviewed face to face will be asked to complete a self completion questionnaire which is very much like this interview schedule.

This information should be read alongside the information leaflet for staff about the Review. In that leaflet we stress that while we want to talk about your work in some detail the purpose of the Review is to explore Caledonia Youth's contribution to promoting sexual health and wellbeing in relation to the funding made available by the Scottish Government. The interview is not a review of you or how you perform individually in your job.

The schedule is a starting point, it may go into areas which you do not feel connected to in any detail, please don't worry about this. The approach is conversational in style and we will be open to guidance from you about what feels appropriate and what doesn't. There may also be things you would like to raise that we have not identified, please feel free to do so.

All staff interviewees will be given anonymity, we will not use your name in the report or use any quotes or make any references which would identify your individual contribution.

These questions are a guide and will help us address Review objectives.

1 - Please clarify your post/role and areas of responsibility.

2 - Please give an overview of your work.

3 - We are interested in exploring the extent to which your work reflects what evidence recommends: ' a multi faceted approach to effective education, information and clinical services' in relation to young people's sexual health.

To assist with this question we will use a series of tables (see A to D attached) which describe such an approach. We are not suggesting that you have been, or must be, doing all these things, nor are we suggesting this is a simple (or complete) tick box of 'must do's'. But, we would like to know your views on:

• Whether and how the work which you do is reflected in the tables which follow. In advance of the interview you may want to complete these tables, or you may prefer to wait until we discuss them in the interview.

Then we would like you to reflect on:

• Whether there are aspects of what you do which could be seen as additional or an enhancement to such a framework.
• Whether and how what you do 'fits' with what may be provided by other agencies.

4 - How would you describe opportunities for support, training or continuing professional development as part of your job?

5 - What would you identify as the key strengths of your work? How do/Can you evidence this? Are there any aspects of your work you are keen to build on?

6 - What would you identify as any areas of weakness, or areas which need to be improved, enhanced or addressed about the work you do?

7 - Do you contribute in any way to developing and delivering (nationally or locally) on national sexual health policy, namely 'Respect and Responsibility'?

8 - Reviewing our discussion so far, or identifying further areas or issues, is there anything you would add?

9 - Do you have any questions about the Review process? Do you have contact details for Review team?

3A - There is emerging evidence which can inform the development of sexual health services for young people in Scotland.

We are interested in exploring the extent to which your work reflects what evidence recommends.

The first set of characteristics are about the extent to which, in your work, you are aware of and/or take account of wider influences in young people's lives.

Could you indicate below the extent to which you feel you are achieving each statement:

3B - The second set of characteristics are about the extent to which, in your work, you address or impact on a number of key areas.

Could you indicate below the extent to which you feel you are achieving each statement. This first matrix is about whether you address these key areas, the matrix which follows is about impact.

i. In my work I address these areas:

ii. In my work I impact on these areas:

3C - We also want to know about the extent to which, in your work, you address the needs of groups most at risk of sexual ill health. Could you indicate below the extent to which you feel you are achieving each statement:

3D - You can now choose to discuss one of the following key areas. If you have a role to play in more than one, you may choose to answer in terms of more than one area. We appreciate this will take extra time.

• EDUCATION
• INFORMATION PROVISION
• CLINICAL SERVICES
• COUNSELLING

In these pages these terms mean the following things:

Risk factors are those things that encourage behaviour that could result in pregnancy or STI or conversely that discourage behaviour that could prevent them.

Protective factors are those things that discourage behaviour that could lead to a pregnancy or STI or that encourage behaviour that can help prevent them.

3D1 - Some statements follow which might describe the EDUCATION work undertaken by Caledonia Youth. Could you indicate below the extent to which you feel in your contribution to this work you are achieving each statement:

3D2 - Some statements follow which might describe the INFORMATION provided by Caledonia Youth. Could you indicate below the extent to which you feel in your contribution to this work you are achieving each statement:

3D3 - Some statements follow which might describe the CLINICAL SERVICES provided by Caledonia Youth. Could you indicate below the extent to which you feel in your contribution to this work you are achieving each statement:

3D4 - Some statements follow which might describe the COUNSELLING SERVICES provided by Caledonia Youth. Could you indicate below the extent to which you feel in your contribution to this work you are achieving each statement:

Stakeholder Interviews

Thank you for your contribution. This schedule should be read in conjunction with the information sheet for Stakeholders about the Review. We have a series of open questions, some will be relevant to you, some may be out with your remit or knowledge. The questions are a guide and will help us address Review objectives.

1. Please clarify your post and areas of responsibility.

2. Please give an overview of how you know/engage with Caledonia Youth.

3. Caledonia Youth has a stated AIM. "To make Caledonia Youth welcoming to all young people in Scotland, responding to their individual needs, upholding their rights and representing their interests. In doing so, we strive for confidentiality, openness, trust, dignity and empowerment in an environment that is approachable, non-judgemental and easily accessible". Could you comment on any aspects of this statement which you feel Caledonia Youth are particularly strong on achieving, and any parts of this statement which you feel Caledonia Youth needs to improve?

4. We are interested in exploring the extent to which Caledonia Youth provision reflects what evidence recommends: 'a multi faceted approach to effective education, information and clinical services' in relation to young people's sexual health.

Attached to this interview schedule are 2 pages which describe such an approach. We are not suggesting that Caledonia Youth has been, or must be, doing all these things, nor are we suggesting this is a simple (or complete) tick box of 'must do's'. But, we would like to use this framework to know your views on:

• Whether and how the work which Caledonia Youth does is reflected in parts A to D as described.
• In relation to A to D whether there are aspects of what Caledonia Youth does which could be seen as additional or an enhancement to such a framework.
• In relation to A to D whether and how Caledonia Youth provision 'fits' with what may be provided by your/other agencies.

5. From your knowledge of Caledonia Youth, how has the agency contributed to developing and delivering (nationally or locally) on national sexual health policy, namely 'Respect and Responsibility'?

6. Reviewing our discussion so far, or identifying further areas or issues, could you

• Identify key strengths which can be built upon by Caledonia Youth?
• Identify and propose solutions to any weaknesses about the agency which need to be addressed?

7. To end: Do you have any final contributions to make?

Information relating to Question 4

The review process will "Examine the extent to which Caledonia Youth provision reflects what the current evidence recommends in relation to a multi faceted approach to effective education, information and clinical services (including contraceptive services)".

Parts A to D which follow suggest what a multi faceted approach might look like, please consider:

A. To what extent does Caledonia Youth work take cognisance of wider influences in young people's lives when they are engaged in aspects of provision?

These may be:

• the social environment
• self esteem
• personal experience and history
• educational attainment
• family structure and relationships
• media influences/media literacy

B (i.) To what extent does Caledonia Youth work address:

• sexual knowledge
• sexual attitudes and beliefs
• sexual behaviours
• the social context/aspects of the young person's life including issues of gender and personal relationships
• the emotional context/aspects of the young person's life including self worth and self esteem
• contraceptive use
• access to other health care
• how other services work

B (ii) To what extent does Caledonia Youth work impact on:

• sexual knowledge
• sexual attitudes and beliefs
• sexual behaviours
• the social context/aspects of the young person's life including issues of gender and personal relationships
• the emotional context/aspects of the young person's life including self worth and self esteem
• contraceptive use
• access to other health care

how other services work

C. To what extent does Caledonia Youth's work address the needs of groups most at risk of sexual ill health? These can be identified as young people who are:

• Living in socio-economic deprivation
• Looked after or leaving the care system
• Young offenders
• From BME communities
• Have a learning disability/difficulty
• Lesbian, Gay or Bisexual
• Living in rural/island areas
• Have emotional/behavioural difficulties
• Excluded from school

Or work, where deemed appropriate, with all young people on some whole population sexual health issues? (eg. Chlamydia testing, terminations, social/cultural issues)

D. To what extent does Caledonia Youth work have these characteristics of effective education, information and clinical services identified by the evidence?

YOUNG PEOPLES SURVEY

Young people's clinic based interviews

Clinic observations

1. Evidence of Aim/Vision

• We welcome all young people
• We respond to individual needs
• We uphold young people's rights
• We represent young people's interests

Services strive for:

• Confidentiality
• Openness
• Trust
• Dignity
• Empowerment

Services are provided in an environment

that is:

• Approachable
• Non-judgemental
• Easily accessible.

Young people's focus groups

Education Sessions observations

1. Evidence of Aim/Vision

• We welcome all young people
• We respond to individual needs
• We uphold young people's rights
• We represent young people's interests

Services strive for:

• Confidentiality
• Openness
• Trust
• Dignity
• Empowerment

Services are provided in an environment

that is:

• Approachable
• Non-judgemental
• Easily accessible.