Background to the scheme.
The Torfaen C-CARD Scheme is funded by, and forms part of, the Welsh Assembly Government (WAG) initiative to reduce teenage pregnancies and sexually transmitted infections across Wales. The main aim of the scheme is to increase the access to condoms and sexual health information for young people, aged 14-25 years old, within Torfaen.

How the Scheme operates.
The Torfaen C-CARD Scheme was launched on February 28th 2003. The Scheme is a distribution network of free condoms and supporting materials, aimed at young people aged 14-25 years old. It is currently operating in a variety of appropriate outlets ('Assessment Centres'), with a good geographical coverage, across the Borough of Torfaen, and is a confidential service.

To obtain a C-CARD a young person has to visit a Torfaen C-CARD Assessment Centre. A trained worker will then spend a minimum of ten minutes ensuring the young person has the information and skills necessary to conduct a healthy sexual relationship. The Fraser Guidelines, which give guidance on providing sexual health advice to young people under the age of sixteen, are adhered to. Once a C-CARD is issued a choice of up to ten condoms is offered. Further free supplies can be obtained by presenting their C-CARD at any of the nominated Torfaen C-CARD Assessment Centres.

How the Scheme was developed.

The Torfaen C-CARD Working Group.
A C-CARD Scheme sub-group was set up from members of the Health of Young People/Sexual Health Steering Group. This sub-group has guided the Scheme and has been an example of good working partnership. Once the sub-group secured the WAG funding, a part-time (0.4 days) C-CARD Coordinator was appointed and took up post in September 2002.

Consultation with young people.
Consultations have provided a vital insight into the need and priorities of young people regarding their sexual health needs, and how they would like the Scheme to be implemented. Consulting with young people is seen very much as an ongoing process, giving guidance for the development of the Scheme. Young people's input has been invaluable in the development of supporting materials, the design of the assessment process and the promotion of the Scheme.

Location of the first wave of assessment centres, and identifying and training support staff.
The initial bid to WAG outlined that in the first year of the Scheme there would be three assessment centres, and that 50% of youth clubs were to operate as pick up points (and therefore unable to conduct assessments). It soon became clear from consultations, with young people and youth workers, that in order to ensure maximum accessibility to the Scheme as many assessment centres as appropriate should be made available. Comprehensive training was provided to youth workers, ensuring they had the knowledge and skills not only to issue condoms, but covering all aspects of the assessment process.

At present there are seventeen assessment centre, in contrast to the initial plan for three. The assessment centres are made up of; four health clinics, ten youth clubs (the remaining four are on the waiting list), the Looked After Young Peoples nurse, the Nook (for excluded young people) and the Rainbow group (bi-sexual, gay and lesbian young people). Research evidence suggests that youth workers are seen as a credible source of sexual health information, and initial feedback regarding the Scheme confirms this.

Resources and Support.
Materials have been developed in consultation with young people. These include a C-CARD Little Book, (to support the information given at assessment), poster and various information leaflets. A Torfaen C-CARD web page has been developed by the Youth Service, information on the scheme can also be found on the LHB website, the Scheme has been promoted on Real Radio (as part of an advert for CCYP) and regular contact is made with the local press.
Ongoing training is offered to all assessors. A manual to support their role has been developed with professional consultation.

The First Six Months

The statistics.
During the first six months in operation more than 630 C-CARDs are known to have been issued. The exact figure is not known because some statistics have not been returned (this has been an ongoing problem) other statistics have been lost in the post and some of the Centres were closed during the school holidays. With one of the aims of the Scheme being to target young men, the gender split of the C-CARDs, whose distribution is known, is particularly pleasing, with 65% of C-CARDS being issued to young men and 35% to young women.

The ages of the young people who were issued with C-CARDS's currently reflects the type of assessment centres available, with 68% issued to 14-15 year olds, 26% to 16 to 18 year olds and 6% issued to 19-24 year olds. Sexually transmitted  infections rates for young people are currently being described in the national press as a 'public health crisis'. Teenage pregnancies still remain a local concern, particularly within the 16-18 year age group. These are issues which can, and intend to, be addressed by the Scheme.

Two differences noticed between traditional sexual health services and the Torfaen C-CARD Scheme so far, have been the types of condoms offered, and therefore selected, and the gender differences in using the services. Firstly, the types of condoms issued. Consultation with young people highlighted the demand for a variety of condoms to be offered, and the Scheme responded to this request. Flavoured, followed by ribbed, condoms are by far the most popular selected in all of the Assessment Centres. Secondly, on the whole traditional sexual health services in Torfaen are accessed by more females than males. This is not the case with the Torfaen C-CARD Scheme, with 65% of C-CARDS being issued to young men.

Comparing Assessment Centres.

Health Clinics. Trevethin Health Centre has issued the most C-CARDS out of all the Assessment Centres, which highlights the accessibility and availability of the assessors. (opening hours are 9am-4pm Monday to Friday) The commitment and positive attitudes of the workers at Trevethin must also be complemented. Pontypool Young Peoples Clinic can only offer one session on a Monday afternoon at present. This is a particularly busy clinic (with reported waiting times of up to two hours) and offers other sexual health services as well as the C-CARD service, and this helps explain why only 12 C-CARDS have been issued.

Youth Clubs. With the youth clubs, some have issued more C-CARDS than others. This can be explained by some of the youth clubs having a larger membership, some being closed over school holidays, lost statistics and some clubs launching the Scheme later than other. The commitment, right from the offset of the Scheme, from youth workers, and their management team must be applauded.

Qualitative Feedback

Concerns prior to the launch.

Concern was expressed by some youth workers that they might have parents or members of the community coming into the youth clubs complaining about the scheme. The concerns were addressed through training and the provision of a leaflet written for parents. To date, there has been no negative feedback from parents, only positive.

There was also concern over the possible misuse of the Scheme. Again, to date, no one person, to our knowledge, has 'over used' the Scheme. Although some misuse of the Scheme must be expected it has not been an issue.

Concerns since the Launch.

Waiting times within the Pontypool Clinic (up to two hours has been reported) has also been raised as an issue, by young people and workers alike. This is something that is unlikely to be addressed in the near future, given a shortage of pace within the Clinic. Given its central position geographically within Torfaen young people would benefit from this service being more 'accessible'. The return of monitoring forms to the C-CARD Coordinator, completed each time a young person is issued with a C-CARD, and/or condoms, has been problematic. I has been very difficult to keep up to date with C-CARD figures. Monitoring forms are rarely sent back monthly as requested (with a few exceptions). Also, the time it takes to input and analyse returned data (currently being undertaken by the C-CARD coordinator) was underestimated. As the Scheme expands, this is an issue needing to be addressed.

Positive comments.

Partner agencies are pleased with the Torfaen C-CARD's progress to date. The Scheme has been approached by six other Welsh agencies and an agency from England requesting information and advice on how it operates. The Torfaen C-CARD Coordinator has made local presentations on the Scheme, and has been invited to facilitate a workshop at the next Family Planning Cymru's Sexual Health Conference. The Torfaen C-CARD has also been promoted at most of the recent local health promotion events.

The Future.

With over 10,000 condoms being issued in six months, seventeen supportive assessment centres with well trained staff, and excellent partnership working, the future of the Torfaen C-CARD Scheme looks good. The Scheme has also attracted additional funding, from the Inequalities in Health Fund, which will allow for expansion. With the Welsh Assembly Government funding due to expire in April 2004, long term funding needs to be secured.

The immediate priorities for the Scheme are appropriate expansion; ongoing evaluation; and continued consultation with young people. There are a number of youth clubs waiting to join the Scheme. Other appropriate agencies are more than welcome to join the Scheme. Consultation has identified the need for outreach work to access 'hard to reach' groups of young people, and the Scheme will support a pilot youth service outreach project later in the year. Targeting of young people who do not access youth clubs and may feel uncomfortable or unable to access clinics needs to be addressed. A pilot project with pharmacists operating as pick up points for the Scheme to help address this gap is currently being explored. Evaluation and consultation has always been paramount to the Scheme, and is ongoing.

Finally, the Torfaen C-CARD Coordinator would like to thank the continued support of all of the Torfaen C-CARD Scheme Assessors and their managers, and members of the steering group. Particular thanks must be extended to Virginia Morgan (senior Health Promotion Specialist, Torfaen) and Caroline Jones (Sexual Health Outreach Worker, Torfaen) for all their hard work, guidance and support.

If you would like any more information on the Torfaen C-CARD Scheme, or would like to discuss the possibility of being involved with the scheme then please contact the Torfaen C-CARD Coordinator, Jackie Williams, by phone (01495) 745660 or by email Jackie,Williams@nphs,wales,nhs.uk

Author Jackie Williams, October 2003.

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