Information and Instructions

• Contraception and medical treatment
• Sexual Health Services
• Consent
• High-risk sexual activities
• Discussion with the child
• Documentation

Contraception and medical treatment




If a young person wishes to discuss contraception you should remind them that condoms are the only form of contraception that can protect against STIs and should be used in conjuncion with other forms of contraception whereever possible.

Everyone has a right to confidential medical treatment, including access to contraception. In Australia there is no minimum age for consenting to medical treatment. The health professional will base this on the ability of the young person to understand the advice or treatment. Where a young person is deemed able to provide their own medical consent, parental consent, or consent from the Department in lieu of parental consent, is not required.


Consent is required from the Department if a young person is not Gillick competent. For more information on providing consent in these circumstances, see Chapter 3.2.8 Medical or dental treatment – including immunisations and 3.2.9 Operative procedures and anaesthetic consent.


This guidance is true for all forms of contraception, even where the treatment may be considered invasive, such as a contraceptive implant.


Medicare will keep information on medical treatment confidential from the age of 14 years. Generally, medical information can only be shared with a young person's permission after they reach 14 years. A young person who has capacity to make their own medical decisions should understand their right to privacy and the confidentiality of their health information.


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Sexual Health Services

In addition to providing the young person with adequate information about consent, safety, and sexual health, you should support the young person to access appropriate medical professionals and support services where required.


Where you are supporting a family and the young person is not in the CEO's care, work with the parents/carers and the young person to follow-through with sexual health medical appointments where required. Practical support to parents, such as help with transport, should be offered where the young person would otherwise not have access to required services, such as STI treatment and/or emergency contraception. 


Where a young person is in the CEO's care and they indicate an interest or need to see a sexual health professional, gather information from them about their specific situation and their needs. You should:


• be respectful of the young person's privacy and dignity.
  

• provide the young person with contact details for relevant agencies and explain what services they provide

• explain what the young person should expect when they attend a specific service. Tell the young person that they may need to attend several appointments, depending on their needs

• ensure the young person has everything they need to successfully attend a clinic or service. For example, will there be a fee and do they have money? Will they need and do they have their Medicare card? Do they know how to book an appointment online or over the telephone?

• ask if they would like practical help or emotional support to attend an appointment? The young person may feel scared, especially if they are attending an appointment for an STI screen or to receive emergency contraception for the first time. If they do, make sure you or someone else the young person knows and trusts is available to take the young person, and

• follow-up with the young person about the appointment and ask if they need any further support. They may have a prescription that needs to be filled and or a referral to a specialist service. Provide reassurance and practical assistance as much as possible. 
  

If a young person advises you that they may be pregnant, support them to get immediate, non-judgemental and appropriate health support. The young person will have a short timeframe to make decisions about continuing a pregnancy and should have access to accurate health information and an explanation of what options they have. Where a young person in the CEO's care indicates they are considering a termination of pregnancy, refer to Chapter 3.2 Termination of pregnancy (abortion).  If a young person decides to continue a pregnancy and wants to care for the child, consider if pre-birth planning is required. If there are concerns regarding how the young person became pregnant, a CSI may also be required to promote the safety of the young person.




The following services are available in the metropolitan area to support young people with their sexual health and related matters:


• Derbarl Yerrigan Health Service
• Sexuality Education Counselling and Consultancy Agency (for people with disability)
• Sexual Health Quarters
• Armadale Free sexual health clinic
• Street Doctor
• Marie Stopes
• Sexual Assault Resource Centre

The Sortli app, which can be downloaded for free, also provides information on sexual health and encourages young people to link in with appropriate health services. This app was developed with input from young people with care experience but is freely available to all young people.





Privacy concerns and access to sexual health services can be greater issues for young people who live in rural and remote areas. Work with a young person to find an appropriate service they feel comfortable with in their area, or if possible, support them to travel to an area where services are available. See the Western Australian Aids Council website for a comprehensive directory of sexual health services, focusing on where to get tested for STI's, across rural and remote areas. Telehealth may also be an appropriate option for a young person.




MAPPA is a website that provides details and the location of all Aboriginal health services in a particular area. This website is run by the Aboriginal Health Council of Western Australia (AHCWA) with the goal of helping Aboriginal people and communities to access health services as close to home as possible. It can also provide the following information:


• Service schedules for visiting and outreach services.
• Travel routes to help you get to the service.
• Relevant cultural information for the area where the service is located, such as Lore time and community events.
• Weather and road condition information. 
  

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Consent

You should not assume that a young person understands 'consent'. Consent should be discussed with the young person and is as important for the young person to understand as other areas of sex education, such as how to have safer sex. If you are unsure if a young person understands consent, ask them. If you - or they - do not feel comfortable having this conversation, ask the young person what adult they would feel comfortable discussing this with and talk to that adult about the importance of the young person understanding consent.

Legally, consent must be "freely and voluntarily given" by a young person who is at least 16 years old. A young person under the age of 16 years cannot legally give consent to engage in a sexual act, even if they agree to it. Young people under 16 years are more vulnerable to abuse and exploitation, so consider each situation on a case by case basis.

The age of consent is the same regardless of the young person's gender, or if they are engaging in a sexual act with a person of the same or a different gender.

Consent cannot be given freely and voluntarily if it is obtained by force, threat, intimidation, deceit, fraudulent means, or in exchange for valuable goods. For example, consent is not considered to be free and voluntary if a person:

• has impaired decision-making as a result of prescription medication, alcohol, and other drugs or substances.
• has diminished capacity due to developmental delay and or cognitive impairment
• is significantly younger chronologically than another person participating in the sexual act
• is offered money, expensive presents, or drugs in exchange for sex
• is engaged in a sexual act with a person who has real or perceived authority over them, and or
• is in a relationship where they are a victim of family and domestic violence (FDV), including where coercive control is perpetrated by their sexual partner.
  




If consent is not given freely and voluntarily, based on the above definition, a criminal offence may have occurred, and the young person may have been the victim of a sexual assault and/or sexual abuse.

A young person may not understand or remember all of the above information, but they should come away from a conversation about consent knowing that:


1. It is always ok to say "No". It is ok to say "No" at the beginning or during a sex act, including where they have previously consented to having sex with the same partner.

2. Consent should be explicit and should be actively communicated.  Silence or a lack of resistance does not equal consent.

For more information about talking to young people about consent, see How to teach your teenager about consent and What is consent? from the Kids Helpline website.


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High-risk sexual activities

You should advise the young person that you have a duty of care to advise the Western Australian Police Force (WA Police Force ) if you hold a reasonable belief that a criminal act has occurred or is occurring in relation to sexual abuse. You should make a report to the police if you believe a young person is engaged in any form of sex work.

Navigating sex and sexual relationships is particularly difficult for young people, particularly where they are provided with incorrect, problematic, or conflicting messaging on social media and in the community. Even with access to appropriate sexual health and relationship information, a young person may still experiment and engage in a high-risk activity, such as 'hooking-up', sexting, watching harmful pornography or engaging in sex work. 

If you learn that a young person is watching pornography and ithas become problematic, suggest they ta to a sexual health professional. Kids Helpline are able to provide support to young people in this area via their counsellors and have helpful information on their website.

If you become aware that a young person is 'sexting' or sharing sexual imagery of themselves or other young people, or engaging in online sex-work (including via an 'OnlyFans' subscription account), you should:


• explain that sharing intimate imagery of a person under 18 years is illegal and that even if they are sharing images of themselves, they could be at risk of criminal charges

• help the young person block and report others who are sending sexually explicit images without consent

• give the young person practical advice on how to manage intimate images of them that have been shared, such as 'untagging' themselves, making a report to the web page, and
  

• explain how to make a report to the eSafety Commissioner  or the police.
  

Where a young person under 16 years agrees to have sex or to be in a sexual relationship with another young perrson of a similar age and developmental stage, you should talk to the young person and determine if this relationship is harmful or abusive. If you are unsure, refer to 2.2 Sexual abuse to help you determine if any action is required to promote the safety of the young person. 


A child under the age of 13 years is never capable of providing consent under the Criminal Code and having sex with a child under 13 years is a serious criminal offence. 

If you learn that a young person aged 13 years or younger has been diagnosed with an STI you must complete a CSI. The Communicable Disease Control Directorate (CDCD) reports all cases of positive STI's to the Mandatory Reporting Service.  Refer to 2.2 Sexually transmitted infection notifications for further information.

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Discussion with the child

A young person in the CEO's care, or who is part of a family group open to the Department, should have access to age-appropriate sexual health and relationship information. Ensure conversations about sex and sexual relationships are purposeful and sensitive to the young person's needs. For example, if you have received information that a young person is sexually active advise them you have received this information and use it as an opportunity to discuss contraception, consent, safety, and sexual health issues. It is important to follow-up with practical support to assure the young person you are genuinely concerned about their health.

If you are not having these conversations with the young person yourself, provide support and guidance, where necessary, to the appropriate engaged adult. Ensure the messaging being provided is consistent, and correct, as receiving conflicting or inaccurate information can be very confusing for a young person.

If a young person tells you they are having sex, you should carefully consider whether it is appropriate to advise their parents/carers. A young person has a right to privacy and dignity and should be able to decide who they share this information with. If you are confident the young person can make safe choices and is not placing themselves or others at risk, you should take direction on what information to share with whom from the young person.


Before talking to a young person about sex or sexual relationships, consider if there are any cultural traditions or norms that should be followed for the young person and their family. For example, are there any rites of passage related to sexual maturation? If the young person is Aboriginal or Torres Strait Islander, you should consult with the Aboriginal Practice Leader (APL) or another senior Aboriginal staff member. For example, should a specific member of the family be responsible for educating the young person? Are there any taboos about sex you should be aware of?

If you are unsure how to provide sexual health information to a young person in a culturally sensitive and culturally safe manner, talk with the parents or carers and the young person directly. It is important to speak with the young person directly as they may not agree with their parents or broader family on what is in their best interests.


Culturally sensitiveand culturally safe practices for providing sexual health information might include:

• individual discussions
• group, family, or community-based meetings
• referral to a health professional known to be culturally appropriate for the family, and/or
• referral to a culturally safe agency, such as Derbarl Yerrigan Health Service. 
  

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Documentation

Health provider ar not legally obliged to provide parents or carers with medical information about young people aged 14 years and over. Before requesting information under s.23 of the Children and Community Sevices Act, consider if this inforamtion is required and if you should seek consent from the young person.

When documenting information about a young person's sexual health, or details of their sexual relationships, consider the following:


• What is the purpose of documenting this information? If there is no clear purpose, should you be documenting it at all?
• Will documenting this information increase safety for the young person, other young people now, or in the future?
• Is this information being documented in a manner that preserves the young person's dignity?




If there is a reason to detail specific information, such as disclosure of a sexual assault, include the rationale for providing this sensitive information in the case note or report.


The young person should be advised of the need to document conversations and actions in a case note, in their health plans or in other formats. They may not initially understand why or what this means. If you have not already had this conversation with the young person about documentation, it is important to reassure them that these files are restricted and to explain why they are necessary.


Consider discussing what information the young person feels comfortable documenting and how they would like it to be written. You may not be able to adhere to the young person's wishes, but discussing their views shows the young person that their opinions and privacy is important.


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