Youth friendly services in Estonia

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Youth friendly services in Estonia

• Kai Haldre, Helle Karro
• Kai Part, Kadri Sikk, Tiia Pertel
• Estonian Sexual Health Association
• Ankara
• March 2, 2006

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ESTONIA
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• Republic of Estonia 1.3 million inhabitants
• Parliamentary democracy
• EU member since 1 May 2004
• Number of young people 1 Jan 2004
• 15 24 year olds 207 748 persons
• (49 females, 51 males)

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Estonia, since the beginning of 1990ties...

• Creation of democratic political institutions and
  a market economy
• Major health care reform
• Polarisation of the society
• Choice and availability of modern contraceptives
  increased
• More sexuality education at schools
• Declining trend in age of sexual initiation
• Quality of care of services improved (youth
  counselling services etc)

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Estonia, since the beginning of 1990ties...

• Abortion rate and fertility rate decreased in all
  age groups
• STI rate increased and in the end of the decade
  started to decrease
• Explosion of HIV epidemic in the end of 2000
  among IDUs

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School sexuality education

• was introduced more systematically in Estonian
  schools in 1990ies
• role of NGOs
• youth counselling services (counselling
  education)

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Youth clinics in Estonia

• Estonian youth clinics were founded over 10 years
  ago by local enthusiasts in Viljandi, Tallinn and
  Tartu
• There are currently 17 youth clinics in Estonia,
  forming a coordinated network
• The working hours of Estonian youth counselling
  centers vary, ranging from 4 to 40 hours per
  week, as do the numbers of staff and visitors

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Rakvere
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Youth clinics in Estoniacommon features

•     Similar working principles youth
  counselling centers approach young peoples
  problems holistically, providing help not only of
  a medical, but also of a social and psychological
  kind, and accepting and respecting individuals
  psychosexual development and sexual rights.

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Youth clinics in Estonia common features

• Similar training of staff
• The Estonian Sexual Health Association (ESHA,
  previously called Family Planning Association)
  took the youth clinics under its wing
• It has organised training involving instructors
  from the neighbouring Scandinavian countries for
  youth clinic staff, has compiled and published
  sex education literature, and has organized
  visits to similar Finnish and Swedish centres
• In 2004 the ESHA initiated a regular youth
  counselor training programme (160 h)

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Youth clinics in Estonia common features

• The clinics are intended for young people of both
  sexes up to the age of 25
• Visits to the clinic are voluntary and the
  service is free
• The clinics are, if possible, kept separate from
  other medical establishments
• Waiting lists are kept as short as possible
• In the clinic young people must feel secure and
  welcome and treated with respect
• Services should be youth friendly," with
  flexible hours, close location, continuity of
  care

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Youth clinics in Estonia

• Individual and couple counseling by a
  gynaecologist or midwife and, in some clinics, by
  a urologist, psychologist, or social worker
• Separate counseling for boys/men in the three
  largest clinics.

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Youth Center should be prepared to deal with

• body changes in puberty
• questions concerning the beginning of sexual
  relationships
• prevention of unintended pregnancies and STIs
• diagnosis and treatment of STIs
• diagnosis of pregnancy
• counseling before and after pregnancy termination
• counseling in case of sexual abuse
• counseling of teenage boys
• Health preserving and preventive care

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Youth clinics in Estonia

• Individual and group counseling in 2005
• a total of 26 070 visits were made to youth
  clinics
• of the visits 96 were made by women and 4 by
  men
• phone counseling 12 754 times
• Sex education in 2005
• 543 sexual education lectures were held

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Online counseling

• Started in 1998, today it has developed into
  www.amor.ee, hosted by the ESHA
• E-mails are answered by a team of 30 specialists
  consisting of gynaecologists, urologists, a
  sexologist, psychologists, a social worker, etc.
• In 2002, online counselling was funded by the UN
  Population Fund, from 2003 to 2005 by the
  Estonian Health Insurance Fund
• In 2002, 872 letters and in 2004 more than 5000
  letters were answered.

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www.amor.ee
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Youth clinics in Estonia funding

• Irregular funding was for many years a common
  concern for the youth clinics, since they quickly
  found acceptance among young people and the
  numbers of visitors rose rapidly
• However, since 2002 the Estonian Health
  Insurance Fund has financed testing for sexually
  transmitted diseases and sexual health counseling
  in youth clinics as part of a 5 year project

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Satisfaction of visitors

• There have been three surveys to assess visitors
  satisfaction with the work of youth clinics. The
  results are encouraging and show that adolescents
  are extremely satisfied and accept this kind of
  service
• The visitors appreciated most the personal traits
  of the staff, their attitude and professionalism
  and comfortable and friendly atmosphare
• They praised the STI counseling and testing and
  the good accessibility of services
• It was suggested that the clinics should do more
  to advertise themselves in schools and media

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Feedback from clients

• No appointment needed and no need to queue in a
  long line
• place to receive a prescription and pills
• can turn with all kinds of problems
• young and competent doctors
• trustworthy, you are treated as an adult
• appointments are private, comfortable and
  convienient, no tense atmosphere
• suitable appointment times and nice furnishing
• Dagmar Kutsar Julika Silma, 2000

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Feedback from clients

• Youth counseling and the Youth Clinic is the
  best thing that has happened in our republic
• The Youth Clinic may save your life! It is
  certainly praiseworthy that the needs of young
  people are also being addressed. I like sex and
  that is no surprise since lots of other people do
  too.
• Is life for loving or love for living?
• From the visitors book of Tartu Youth Clinic by
  Terje Peetso

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Some lessons learnt

• Something remarkable may grow from a small
  initiative done with all heart
• Dedicated people are the biggest property, funds
  will be available sooner or later
• RH/SH services should be designed from the very
  beginning for both men and women
• Collect continously feedback from the young
  clients (eg guest book) - very helpful
• System of regular audit and common data
  collection basis for reliability and improvement

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Youth clinics in EstoniaFuture

• improving the quality and continuity of the youth
  counseling service
• fighting the HIV epidemic
• raising the share of men and boys among the youth
  clinics clientele
• regular training for youth clinics staff
• sharing our experiences with others (outward
  looking)
• supporting sexual education in schools

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Conclusions

• The Estonian youth clinics have so far certainly
  proved their worth, and it is likely that they
  help to reduce sexual health related risks among
  young people