The S Words: Sexuality, Sensuality, Sexual Expression and People with Intellectual Disability

Service models for providing sex education to individuals with intellectual disabilities in the United States

Individuals with intellectual and developmental disabilities face barriers to accessing sex education, including a lack of professional ownership over providing sex education. Limited information exists regarding educator training background, funding structure, and who they serve. We interviewed 58 sex educators of individuals with intellectual and developmental disabilities. We integrated thematic analysis and composite narratives to identify service models and the benefits and challenges associated with them. We identified seven service delivery models: clinic-based board-certified behavior analysis; mental health therapists; small businesses; public health not-for-profits; disability programs; high school-based educators; and university-based educators; and three themes that addressed the strengths and challenges of these service models: Instructional Implications of the Short-term, Drop-in Approach; Getting on the Same Page; and Questioning Who Should Teach Sex Education. Understanding these typologies and their strengths and challenges provide insights into how we can build capacity for sex education services.

A tool for assessing sexual knowledge of people with Intellectual disabilities in Norway

Background

Previous research has shown that people with intellectual disabilities have limited sexual knowledge, which can be essential for developing positive sexuality. This study aimed to check the validity and reliability of an assessment tool (SexKunn) for measuring the sexual knowledge of people with intellectual disabilities in Norway. Further, we aimed to identify potential knowledge gaps among the participants and highlight their potential impact.

Methods

37 people with intellectual disabilities completed one assessment. 20 participants then completed a retest. Clinicians' (n=23) views on the assessment tool were measured to obtain face validity. Positive and negative agreement analysis was used to identify potential dimensions in the data.

Results

A weighted Cohen's kappa for the test and retest of the overall scores was considered to be substantial. The clinicians described an acceptable face validity regarding high positive value scores and low negative burden scores. They also suggested improvements. The study identified that the participants lacked knowledge about female genitals, hygiene, appropriate touching/sexual acts with friends/intimate partners, and contraception.

Conclusions

The SexKunn is a feasible assessment tool to measure sexual knowledge in people with intellectual disabilities. A lack of sexual knowledge of people with intellectual disabilities may violate their sexual rights.

Sexual and Reproductive Health Education for Youth with Intellectual Disabilities: a Mixed Methods Study of Professionals' Practices and Needs

We conducted formative research to inform the creation of innovative new tools and strategies to engage professionals in communicating with youth with intellectual disabilities about sexual health. The research was guided by a multidisciplinary network of experts and an advisory board of self-advocates with intellectual disabilities and caregivers that make up Project SHINE: the Sexual Health Innovation Network for Equitable Education. A cross-sectional mixed-methods study utilized survey data from 632 disability support professionals who provide services to youth ages 16-24 with intellectual disabilities (ID). We then conducted focus groups with 36 professionals to obtain more in-depth information related to organizational support needs and suitable contexts, methods, and tools for sexuality education. Participants included licensed/credentialed direct service professionals (social workers, nurses, teachers), non-licensed direct service providers (case managers, supportive care specialists, residential care line staff), and program administrators. Quantitative and qualitative data analyses triangulated the findings across four content areas: attitudes about providing sexual health information to youth with ID, preparedness to communicate about sexuality, current communication practices, and professional needs in the field for new teaching tools and methods. We discuss how findings can be used to guide the creation and successful implementation of innovative new sexual health learning tools for youth with intellectual disabilities.

Decision-making support: the impact of training on disability support workers who work with adults with cognitive disability

There is growing recognition that people with disability have the right to be involved in making decisions that affect their lives. Decision-making support has emerged as one way to support people with cognitive disability to make decisions, however, there is a paucity of research that explores how disability support workers can be upskilled to provide decision-making support to this group. The aim of the research was to explore the impact of an evidence-based online training course on disability support workers of adults with cognitive disability. Changes in knowledge about decision-making support and confidence in providing decision-making support were explored, attitudes towards decision-making support, and facilitators and barriers. Participants completed an online training course and responded to a survey on three occasions: baseline, post-training, and at 2-month follow-up. Ninety-nine disability support workers across Australia participated in the online training and completed the baseline and post-training surveys. Thirty-six participants completed the training and all three surveys. The results revealed that there were statistically significant improvements in knowledge, confidence, and attitudes from baseline to post-training, which were maintained at 2-month follow-up. Barriers to decision-making support included service providers or other supporters, including the family of the person with cognitive disability, whilst a key enabler was knowing about the decision-making support principles. This research demonstrates that an evidence-based online training course about decision-making support can be effective in building capacity in disability support workers. There are, however, several barriers that must be addressed to facilitate the implementation of decision-making support.

Sexual Self-Determination of Individuals with Intellectual Disabilities-A Possible Philosophical Conceptualization and Resulting Practical Challenges

(1) Background: Self-determination is one of the central values of many societies. Self-determination concerns many areas of life, including sexuality. Unfortunately, the sexuality of individuals with intellectual disabilities (IID) is often discriminated against, and even in their everyday care, sexuality is often given too little space, not least because of knowledge deficits of parents and staff. A practicable conceptualization of sexual self-determination is a prerequisite for helping IID to achieve self-determined sexuality. The aim of this paper is to formulate such an applicable conceptualization and to discuss related challenges. (2) Method: This paper uses Harry Frankfurt's hierarchical conception of desires and the WHO definition of sexuality to develop a suitable understanding of sexual self-determination. (3) Results: The mentioned concepts offer promising tools to develop a conceptualization of sexual self-determination with high practical applicability. (4) Discussion: Sexual self-determination involves decision-making processes in relation to the different dimensions of sexuality. IID do need support to come to these decisions. Challenges that might be involved with such decision processes will be discussed.

Development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S)

BACKGROUND

This paper presents a description of the development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S).

METHODS AND PROCEDURES

The study included 281 people with mild intellectual disabilities. The psychometric properties were examined through exploratory factorial analysis, descriptive statistics, and reliability indices.

RESULTS

The exploratory factor analyses offered a structure with three factors: concern about the appropriateness of their sexual behaviour, sexual practices performed, and safe sex practices. The model presents an excellent fit (χ² /df = 1.10, RMSEA = 0.019, CFI = 0.997, TLI = 0.995, and SRMR = 0.065). General test reliability was good (α = 0.77, Ω = 0.76).

CONCLUSIONS

SEBECOMID-S is a valid and reliable tool to obtain objective information about the sexual behaviour and concerns of people with mild intellectual disabilities. The use of this instrument will make it possible to adjust their training to their real experiences, making it more effective.

Securing sexual justice for people with intellectual disability: A systematic review and critical appraisal of research recommendations

BACKGROUND

People with intellectual disability contend with significant restrictions to their sexual expression and partnered relationships. This review examines the types of recommendations scholars offer in their qualitative research involving participants with intellectual disability discussing sexuality and intimate relationships.

METHOD

A systematic review of peer-reviewed studies published between 1972 and July 2018 yielded a sample of 26 studies. Thematic analysis was used to taxonomize scholars' recommendations.

RESULTS

Six distinct forms of recommendations were identified. The most frequently offered and most strongly emphasized recommendation across studies aimed to change individuals with intellectual disability. In contrast, a minority of studies prioritized engaging individuals as informants, eliciting individuals' wishes, enabling relationships and fostering ideological change. No studies placed the greatest weight on promoting systems change.

CONCLUSIONS

Recommendations in the literature have predominantly emphasized individual as opposed to environmental changes. I consider the ramifications of this and argue for a reorientation towards systems change.

'People with intellectual disabilities living in the communities is bad enough let alone…having sex': Exploring societal influence on social care workers' attitudes, beliefs and behaviours towards support for personal and sexual relationship needs

BACKGROUND

Services have a duty to uphold the personal and sexual relationship (P&SR) rights of adults with intellectual disability. However, little is known about how social care workers' (SCWs) perceptions of public views of intellectual disability and sexuality might affect their attitudes, believes and behaviours towards supporting P&SR needs. This exploratory study addresses this gap in knowledge.

MATERIALS AND METHODS

Qualitative interviews using critical incident technique were conducted with 18 SCWs. Data were transcribed and thematically analysed.

RESULTS

Four dominant themes were identified; socio-cultural, practice-policy gaps, fear and safety needs. These highlights how perceptions of public attitudes impact on SCWs' attitudes towards supporting development of P&SR both directly and through perceptions of organisational policies. This leads to prioritisation of safety needs over support for P&SR.

CONCLUSIONS

Public expectations strongly influenced SCWs' interpretation of organisational policy, emphasising a need for practice-based support to manage public expectations and reduce fear.

Making Connections and Building Confidence: A Study of Specialist Dating Agencies for People with Intellectual Disabilities

Dating agencies are a small, but growing sector of social care provision for people with intellectual disabilities. The research reported here is the first to explore, with 10 specialist agencies in the UK, why they were set up, how they operate, the barriers and problems they encounter and their success or otherwise in facilitating relationships for people with intellectual disabilities. A strong case is made for the proliferation of such services.

Deafening silence on a vital issue: The World Health Organization has ignored the sexuality of persons with disabilities

In 2016, the World Health Organization, through the Global Cooperation on Assistive Technology Initiative, issued the Priority Assistive Products List which is meant to be a guide to member states of the 50 assistive products needed for a basic health care and/or social welfare system; it is also a model from which nations can develop their national priority assistive products lists. The aim of this opinion paper is to share my views about the Priority Assistive Products List on the grounds that it makes no distinct mention of sexual assistive devices, yet research has indicated that sexuality is an area of great concern for persons with disabilities. In any case, sexuality forms a core part of being human, and it impacts on both the physical and mental well-being of all human beings. I conclude in part that, in its present format, the list perpetuates the myth that persons with disabilities are asexual beings who are innocent of sexual thoughts, feelings and experiences. The list also propagates the stereotype that sexuality is a sacred, private, bedroom matter that should be kept out of the public domain, to the detriment of the health and well-being of persons with disabilities.

Sexuality in the lives of people with intellectual disabilities: A meta-ethnographic synthesis of qualitative studies

BACKGROUND

The normalisation movement calls for more recognition of the sexual rights of people with intellectual disabilities to challenge classically paradoxical cultural beliefs: 'hypersexual' versus 'asexual'.

AIMS

This meta-ethnographic qualitative synthesis aimed to explore the voices of people with intellectual disabilities in regards to their experiences and perceptions of sexuality using a Coordinated Management of Meaning framework to derive new conceptual understandings of how their sexuality exists within multiple contexts.

METHODS AND PROCEDURES

A systematic literature search and quality assessment yielded 16 studies that met the inclusion criteria and were synthesised following the method of meta-ethnography.

OUTCOMES AND RESULTS

Four core themes were identified; 'Sociocultural Norms'; 'Under Others Power'; 'Sexual Identity' and 'Sexual Experience'.

CONCLUSIONS AND IMPLICATIONS

Application of the hierarchical Coordinated Management of Meaning model suggested caregivers contextual beliefs about people with intellectual disabilities' sexuality inhibited or facilitated positive expressions of sexuality over and above individual needs and desires. Rights-based cultural messages provided the only context that led to positive sexuality outcomes and research that explores sexuality within this context is much needed. The Coordinated Management of Meaning model identified by this research may act as a framework to support the reflective-practice of caregivers.

Sexuality issues and the voices of adults with intellectual disabilities: A systematic review of the literature

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. Individuals can face challenges, including the right to express their sexuality and to access necessary education and supports.

AIMS

This systematic review explores sexuality experiences, the views and opinions of adults with intellectual disabilities and highlights areas for future practice developments.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from January 2006 to December 2016 was carried out. Included studies had to address specific criteria including: peer reviewed papers, the use of appropriate research methods, and focused exclusively on the individual views and opinions of people with an intellectual disability. The search of relevant databases yielded 230 hits. Following the application of explicit inclusion and exclusion criteria, 23 papers were deemed suitable for the review.

OUTCOMES AND RESULTS

The data were analysed and key themes were identified that included: autonomy v's risk of harm, knowledge and sexuality, relationships and intimacy, self-determination and taking control, and encouragement and supports.

CONCLUSIONS AND IMPLICATIONS

Adults with intellectual disabilities need education and support to express their sexuality and to meet individual needs.

[Sexual health and intellectual disability: a narrative literature review and its implications for nursing practice.]

Issues associated with affectivity and sexuality in the context of intellectual disability have recently been the subject of various interdisciplinary discussions in academia. In nursing, interventions in sexual health are supported with hesitation and those issues constitute a marginal field of nursing research. A narrative literature review was realized in order to establish a portrait of the knowledge produced on this topic in the last decade. This paper illustrates three specific research areas recently developed, namely issues related to sexual autonomy, contextual factors positively or negatively contributing to emotional and sexual life, and the experiences of people identified as having an intellectual disability in this regard. On the basis of these results, different issues related to sexuality and intellectual disability are discussed, including those associated with the negotiation process of affective and sexual life, parenthood as a mediator of emotional and sexual expression, and the inclusiveness issues of sexual diversity in health interventions. Implications for nursing are finally discussed in light of the recent development of its role in sexual health.

Pleasure, sex, prohibition, intellectual disability, and dangerous ideas

The sexual lives of people with intellectual disability continue to be the subject of prohibition and restriction by disability sectors. Without access to sex education and the concomitant sex literacy, people with intellectual disability are denied the essential conversation about sex, sexual expression, and pleasure. The authors explore the history of sexual repression of people with intellectual disability, and the culture of sexual disempowerment. This propositional paper offers a sense of hope about sex facilitation and sex education for people with intellectual disability which can afford them a full life.

The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature

BACKGROUND

People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard.

AIMS

The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review.

OUTCOMES AND RESULTS

The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions.

CONCLUSIONS AND IMPLICATIONS

There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments.

Model of Intellectual Disability and the Relationship of Attitudes Towards the Sexuality of Persons with an Intellectual Disability

The following article discusses the relationship between the model of intellectual disability and the attitudes towards sexuality of people with disabilities. This correlation has been verified during the author’s own research conducted on students of several medical faculties such as nursing, public health, emergency medical services and physiotherapy. Tools of the author’s design have been used in the research. Likert-type scale “Perspective of intellectual disability” has been used to determine the model of disability seen from the medical (individual) or social perspective. To examine the attitudes towards sexuality two tools of the author’s own design have been used: a Likert-type scale “The essence of sexuality in persons with an intellectual disability” which has been used to analyze the cognitive aspect of the attitudes, and a semantic differential with notions concerning physical and psychosocial aspects of sexuality including the affective-evaluative aspect. As expected, significant correlations have been found between the model and the attitudes both in the cognitive and the affective-evaluative aspect. Higher scores for the individual model correlated with: (a) lover scores for most aspects of sexuality of people with intellectual disability, (b) perceiving them as asexual, (c) biological determinism in the sexual sphere. The social model concurred with positive values given to sexuality of people with intellectual disability and its normalization in the sphere of its determinants and symptoms.