Social Workers' Perspectives on Sexual Health Education for People with Disabilities: A Lifespan Perspective

Background: The sexual and relational health of people with disabilities (PWD) across the lifespan has been doubly restricted by their exclusion from discourse and education regarding sexuality. Children have been excluded due to social constructs considering them asexual and innocent, and of sexuality as beginning with puberty; adolescents and adults with disabilities are also often thought of as asexual or face obstacles to expressing their sexuality. The sexuality of PWD needs to be addressed from lifespan and social justice perspectives, which consider sexuality as lifelong and integral to humanity. Social workers’ viewpoints and roles regarding the sexual health education of PWD are understudied. Our research questions were: How are social workers providing PWD with sexual health education and what are their perspectives concerning the sexual education needs of these populations? 

Methods: Social workers that served children, adolescents, adults, or older adults with disabilities were purposefully recruited to participate in this study. Interviews were conducted with social workers (N = 41; 3 BSW, 38 MSW) from two western and one southern state. PWD included intellectual disability, Autism Spectrum Disorders, Down syndrome, Cerebral Palsy, seizure disorder, stroke, head injury, and terminal illnesses. Social workers (79% female, 59% Caucasian) ranged in experience from 4 - 43 years (M=17.46 (10.25)). Interviews were transcribed and coded thematically using inductive content analysis.

Results: Social workers serving PWD across the lifespan communicated several of the same key themes: First, PWD received insufficient sexual health education, often as a result of societal (e.g., policies), parental, or practitioner discomfort. Second, responsibility to educate PWD was often deferred to others (e.g., parent to school, social worker to school nurse). Third, social workers’ roles in serving PWD toward sexual health often emerged from contexts of “problematic sexual behaviors”. Finally, social workers highlighted the need for disability-specific resources to encompass sexual and relationship health as well as prevention of STIs, pregnancy, and sexual assault. Differences emerged with regard to social workers’ experiences serving various age populations (e.g., those serving children as preparing them and their families for future romantic/sexual relationships that their parents did not envision), including how to meet the educational needs of differing age groups (e.g., individual practice using internet-based tools for children; groups for older adults).

Conclusion and Implications: Our findings parallel a troublesome discourse concerning a lack of sexual citizenship for PWD in that most of practitioners’ work stemmed from contexts labeled as sexually problematic. A lifespan perspective allowed for a unique observation concerning how this discourse is applied in social work practice across the lifespan. Although encouraging that many social workers voiced a need for comprehensive, tailored sexual health education for PWD, few social workers challenged the dominant discourse that kept them bound to serving PWD as reactionary interventionists rather than as advocates for their full inclusion as sexual citizens. We will discuss trends and differences in findings across each cohort of interviews and highlight implications for social work education and practice, with special attention to ensuring the healthy sexual development of youth.