Sexuality Lecture

Intellectual and Adaptive Skills

The lecture mentions a lack of a specific sexuality domain within intellectual and adaptive skills assessments.

Where Does Sexuality Fit?

Sexuality assessment can be multi-faceted, potentially fitting into self-care, home living, or social skills domains.
Sexuality is viewed as a complex aspect of socialization and communication.

Sexuality as Socialization

Different levels of intimacy exist in relationships, ranging from intimate partners to acquaintances.

Sexuality and Communication

Communication is essential in sexuality, encompassing consent and expressing preferences.
Consent: Explicit verbal consent is required (saying "yes").
In California, the law was changed so that the absence of a "no" does not imply consent; an explicit "yes" is required.

Expressing Preferences

Open communication about likes and dislikes is crucial for mutually gratifying relationships.

Health and Safety

Health and safety aspects include awareness and prevention of STDs/STIs.
Hygiene practices (cleaning before/after sexual activity) are discussed.
Psychological aspects involve recognizing and addressing coercive relationships where individuals may be afraid to say no, especially if economically dependent.

Defining Sexuality

Sexuality encompasses expressing oneself as a sexual and intimate being.
It relates to the human need for closeness and connection.
The importance of touch and appropriate touch in clinical settings is highlighted.

Sexual Development and Cognitive Regulator Model

Roy's cognitive regulator model is used to understand sexual development.
The cognator system involves sensory input and processing of information, example touch.
Cognator: Processes information related to arousal or interest such as touch and pheromones.
Pheromones play a role in attraction at an unconscious level.
Regulator: The regulator system refers to the action or response.

Informed consent is crucial; the inability to process information for informed consent can lead to non-consensual actions.
Understanding the implications of STDs and the risk of pregnancy is essential for consensual activity.

Historical Misconceptions

Historically, people with developmental disabilities were often considered asexual or hypersexual.
The misconception that if they had the mental age of a 2-year-old they weren't sexual. Even if their body went through puberty, in fact, they were not sexual beings because two year olds are not sexual.
Lack of addressing sexuality led to illegal actions due to family members' denial of their sexual needs.
Even today, discomfort persists in discussing and acknowledging the sexual needs of individuals with developmental disabilities.

Facts Regarding People with Developmental Disabilities and Sexuality

People with developmental disabilities have sexual needs like anyone else.
Many individuals do not receive comprehensive sex education from their families.
Peers and the internet often become sources of information, which can be distorted.
It's essential to ensure clients understand the consequences of sex.

Human Sexuality Assessment (Page 103)

A tool used to determine strengths, weaknesses, and training opportunities.
The very first thing on this form, the very first question is does the person respond to his or her name? The ability to respond to one's name is considered fundamental.
It ties to Erickson's stages of development, specifically trust versus mistrust. "Say my name. Say my name."
Laying the foundations for the ability to have relationships with other people on a trusting level.
The ability to tolerate someone being in their space is necessary for closer contact and intimacy.
Recognizing others can meet their needs reflects trust versus mistrust.
Initiating contact with peers is important for forming relationships.
Recognizing familiar vs. unfamiliar care providers is crucial for safety and appropriate behavior.
The ability of a person being able to recognize the difference between a familiar and an unfamiliar care provider.
Head, Shoulders, Knees, and Toes song to identifying body parts. The ability to identify body parts.
Teaching body part differentation. Teaches that there are body parts that are private that people should not touch without your consent.
Private body parts include genitals, buttocks, and breasts; contact with these requires informed consent.
Masturbation: Ensuring it occurs in private and appropriate places.

Importance of Saying No

Teaching clients to say "no" is as crucial as teaching them to say "yes."
Example asparagus. You want them to be able to say that it's okay to say no.
It's essential for protecting against potential abuse or exploitation.

Understanding Sexual Intercourse and Consequences

Assessing whether clients understand the basic functions and concepts of sexual intercourse.
Assessing Understanding of potential consequences.
The understanding of pregnancy and the understanding of STDs.

Training

If a client does not respond to a single question, it indicates numerous areas for potential training.
Rather than saying they're not ready for training, literally we have 40 different areas in which this client can potentially be trained.
The first step might be teaching them to respond to their name.

Legality

*Legality is a critical aspect of sex and sexuality, necessitating education and awareness.
*Age of Consent in California: 18.
*Romeo and Juliet Laws:
* California does not have Romeo and Juliet laws.
* If under the age of 18 the act isn't consensual.

Principles

If an action isn't illegal and informed consent is given for an activity the person is free to do so regardless of personal feelings.
This extends to choice of partner and same-sex relationships, emphasizing non-interference with legal, consensual activities.
Staff should not educate clients because of their beliefs.

Responsibility

If something is illegal, our responsibility is education, providing information before stopping/reporting the behavior. Education is our best friend.
The fragility X brothers being able to babysit but don't know that you cannot abuse nieces and nephews.
We have to tell people that you do not engage in intimate behavior with people that cannot give informed consent.
Training should be appropriate to the individual's cognitive level.

Hypothetical Scenario

A client going on a date, being able to give informed consent, going out with someone who can give informed consent and asks for a condom (a good thing because it shows they are being responsible).
Consent
*Knowlege, Voluntariness, and Free Coercion.

Examples

Two individuals engaging in behavior that requires informed consent at an appropriate time and place: walk out, close the door; otherwise stop and redirect the behavior.
Two clients that are unable to give consent and are engaging in behavior that does not require informed consent at an appropriate time and place: leave alone.
Two clients unable to give informed consent engaging in behavior that requires informed consent: interrupt, redirect, and address the situation in special IPP meeting.
Client who is able to give informed consent engaging in behavior with someone who unable to give informed consent: stop and report abuse (a crime).

Aspects of Consent

Knowledge: Understanding consequences like pregnancy and STDs.
Voluntariness and Absence of Coercion: Ensuring free choice and understanding of choice-making.
Free choice voluntary aspect, do you even understand the concept of choice making?
The coercion aspect of it. The individual as the right to decide who I'm going to be intimate with.
The Individual Understands That Consensual Act Sexual Activity Must Be Consensual Between Two Adults.
Consent concepts, knowledge, voluntariness, harm, exploitation, abuse.

Focus of Sexuality Training

Focuses less on mechanics (how things fit together) and more on consent and legal aspects.
The consent aspect is that a person is at least willing to explore from legal aspect of what they want to do.
Important Areas of Assessment: capacity to consent and training needs.

Consent and It's Levels

When something involves genital, pregnancy, and STDs that is and important question.
Engaging in behaviors that require consent and engaging in behavior does not require consent.
If there is no risk of sexually transmitted disease, pregnancy, or it involves a private body part; our the rule of thumb test is that it is required informed consent.
Important Note: When the test uses the word consent it means informed consent.
If two clients are holding hands (that requires some form of consent but not informed consent.)
Two friends walking down the street holding hands = does not require informed consent.
It is is inappropriate to touch a student, one of you without your permission.
*What are some things you can do in an intimate relationship? Describe what kissing is (touching)?

Example with Roommates

*Sleeping Nude, but not illegal, or clients roommates, not at that point illegal.
*Client privacy and safe gaurds should be addressed.
*Are we going to force the client to wear pajamas or get a private room? (No)
Example from classroom when a students dormmates are loudly having sex (address privately, draw the curtain, arrange some private time outside for them and other roommates.
*Masturbation: has one for the most powerful intrinsically reinforcers. the focus needs to be on time, and a perfect place because you are gonna get them to stop it (training, timing, the place).