Working With Young Men in Sexual Health Services 4

Working With Young Men in Contraceptive and Sexual Health Settings 4

Young men can attend our services full of anxiety which can be accompanied by an exhibition of macho behaviours. The way that we communicate with young men in services needs to demonstrate that we value them, that we understand what they want from the service, that attending such services is a big deal for them and, that with all this in mind, we need them to behave in a certain way and to follow certain procedures.

Working with young men in clinics mostly involves explaining procedures, asking them to do things and sometimes asking them not to do things. Below are some tips on how to communicate with male clients in clinics

Young men tend to respond to brief and clear communication so try to avoid waffling about procedures or policies. Think about what the client needs to know and try to say it in one or two clear sentences.

For example when explaining about confidentiality to male clients “this is our confidentiality policy, it basically means that if I tell anyone I’ve seen you without asking you first I can get sacked”.

It’s important to use clear straightforward language with young men. This means avoiding euphemisms and saying things as they are (eg penis or dick rather than ‘private parts’ or ‘tackle’). Also young people don’t see a distinction between family planning clinics and GUM services – they see them all as ‘sexual health service’. Client rather than ‘patient’ (they aren’t ill), also check-up rather than screening.

Young men often do not understand clinical language or have no connection with it (for example “piss/pee hole” rather than “urethra”). To make it relevant it needs to be in a language that they understand.

Young men use slang but it doesn’t mean that you should in order to make yourself understood. This is because a) you may not be totally clear what the slang means to that young man, b) they might not be very clear what it means, c) it makes you try to look ‘street’ and part of their gang – this can be embarrassing and the point of slang amongst young people is to make them sound different to people like you! Also they are coming to us because we are the highly trained professionals: who are also friendly, warm and clear.

A useful icebreaker can be to ask them what something means or even to say that you know what it means but not use it yourself.

Young male clients deserve a warm welcome to services and deserve to be valued and treated with respect. However this does not mean appearing over-friendly. Remember that to make young men feel comfortable they need to accept that attending your clinic is a masculine thing to do. Being touchy feely in approach at first can be off-putting. There is a great example of this in this research from Steve Pearson here where young men are wary of workers with bean bags being too friendly.

For an initial welcome try ‘alright?’ rather than ‘HI! How are you?’ Also although eye contact is important it is a good idea to use this sparingly at first as it can be quite intimidating.

Large groups of young men can be intimidating – even for experienced workers. They can also be a rarity in some clinics. It’s important in both cases to appear cool and confident and show that it is not a big thing. The more they feel that it is normal for young men to come in, and that you see groups of young men all the time, the better.

Being ready for groups of young men by having a ritual that you always follow can help this. Groups of young men often come in on recommendation from their friends who will have informed their friends about the rituals that happen – where they sit, who is on reception, how long to wait etc.

When first seeing male clients if you are unsure how to come across take clues from their body language. For example

  • If they don’t like eye contact don’t try to establish it;
  • if they have a closed body posture make sure that you give them space;
  • if they are speaking quietly speak at the same volume;
  • if they are making jokes to feel more comfortable laugh along;
  • if they want to shake hands and call you mate do the same.

Usually you will sense when the client is more comfortable and you’ll be able to be increasingly open and friendly.

Understanding the difference between external (dough) and internal (jam) masculinities is vital when we a offering a clinical service for young men. In the waiting room young men are still in external mode, knowing that, at some stage, they are going to be asked very personal questions, be examined and be treated: a potentially very non masculine experience. This can lead to some inappropriate behaviour from clients or a less productive consultation.

Doctors, nurses and health advisors working with young men must have a good idea on how to help facilitate this process; much of it is down to basic client care and having the basic rituals each time a client visits. Not being a clinician I’m not an expert in how this is done but I suspect that the following are important:

  • Having the same ritual each time a client is seen; the way clients are called from the waiting room, the body language and eye contact used and the way their role is introduced.
  • That clients having some knowledge about the process and what is going to happen (particularly with regard to tests) before they happen.
  • That confidentiality is consistently assured throughout the visit.
  • There is a clear space for the client in the consultation room and they are allowed to feel comfortable.
  • Giving clients excellent care but making sure that they get the impression that examining clients and taking sexual histories is standard practice that clinics do all the time (proformas of questions may help with this)

Most challenging behaviour from young men in clinics is not problematic at all – just different. Young men can be energetic, loud, funny, use up a lot of space, need lots of stimulus, sociable and curious. When taking a view on behaviour of young men in a waiting room ask yourself whether there is a real problem or whether they are merely behaving like young men. Are the following really problems?

  • Loud conversations
  • Walking around the waiting area looking at posters or coming in and out of the waiting area
  • Talking on phones or even playing music from them
  • Low level play fighting whilst sitting next to their mates
  • Talking to other people waiting

It is important not to have to challenge lots of behaviour. Some of the above might be problematic in some clinics but should be handled with a softer touch such as a discrete finger on lips, playful but stern look for example.

If there is a genuine problem such as

  • Inappropriate advances on other clients
  • Inappropriate comments to staff
  • Roaming around corridors
  • Intimidating posturing

Avoid shouting

Shouting can create immediate irresolvable conflict. Young men are used to being shouted at and will shout back upsetting you, themselves and the whole clinic. Even calling loudly across a clinic can have a seriously fractious affect – no matter how polite or justified you are.

Make a point of being strong but fair.

Young men have a strong respect for rules if they are enforced fairly. Make sure that everyone is treated the same way – regardless of gender or age. Don’t be scared of being assertive but avoid escalating any tension.

Be polite, quiet, on their level and use humour.

If you have to have a word with clients ensure that you sit with them and are quiet so that they aren’t told off in front of the clinic waiting area. Use of humour is good if possible “are you chatting someone up in my clinic? Is there nowhere else that you can go to do that?”

Have a good reason and get your facts straight

It is vital that you have a good reason for challenging behaviour and it is important (in the interests of fairness) to explain the reason. It is also important to make sure that you clarify with them what they have done. For example

“Were you wondering up and down the corridor? I know it’s boring waiting but you can’t do that because we need to make sure that the service is confidential and safe. Are you ok with that?”

Or “I’m sorry but it’s not really an appropriate place to chat people up because people can be very upset coming here and that can make it much worse”.

Remember that you are in control and have quite a lot of power. Many clients will not understand what is expected of them in a clinic as it the only place where young people are where we expect them to sit quietly and not talk to each other. This can be very confusing. They are waiting for a service from you and they are probably anxious and uncomfortable.

Until recently I thought that having ground rules on the wall would make the service feel less young people friendly. After having discussed this with clients I now realise that I was completely wrong! Rules give everyone a clear boundary of behaviour and are for potential ‘perpetrators and victims’ – so that clients who are offended by bad behaviour can feel confident in reporting it to a member of staff.

When working in clinics we professionals are reasonably clear about the kind of behaviours that we do not want to see (see above): but why should young people share our view? Young men have a strong respect for very clear rules, which are fairly and strictly adhered to; and, even if we still have to tell them off they at least understand that they have broken a rule and are out of order.

The best way to develop a set of rules, is to start by discussing it with colleagues and then circulate a draft to clients. Ask clients about the wording, whether there is anything they want to include or take out. In my experience this has opened up a useful dialogue about why some behaviours are out of order.

When you have some rules make sure that they are clear and specific rather than euphemistic and theoretical (eg please do not make fun of people for being here, rather than, please respect other people using this service). Also ensure that everyone sees them and be prepared to explain why you have the rule.

Here’s an example of the one I did for our clinic

Part Five

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