Workshop 3: 5-14 MDVI: Sexuality in the Context of Personal and Social Development - devising policy and guidelines.

From the Conference: Sex Education for Children and Young People with Visual Impairment, Scottish Sensory Centre, March 1998

The Distinction between Policy and Guidelines
Why do we need a formal structure of policy & guidelines?
The Process of Drawing up Guidelines
Suggestions for Themes for Inclusion in Guidelines
Sex in Context
Methods and Approaches
Personal Relationships and Sexuality
Examples of Positive Approaches to Intimate Care
Practical Considerations for Managers
Questions Related to Requirements for Good Practice
Policy and Guidelines Structure
Bibliography

The Distinction between Policy and Guidelines

POLICY- a general statement of the establishment's philosophy and aims
GUIDELINES- specific written guidance for staff within the ethos of the policy which will inform and shape good practice

Guidelines might be prefaced with some important do's' eg:

• Make sure that children and young people feel involved in and the focus of personal care, ie having things done with them not to them.
• Only talk about a child/young person in their presence if they can be part of the conversation.

Why do we need a formal structure of policy & guidelines?

• Safeguards for pupils and staff, promoting the safety and well being of all concerned
• Openly acknowledge pupils' sexuality and right to learn about it
• Provide security to staff and reassurance to parents by specifying the establishment's philosophy and practice responses to situations
• Provide opportunities for staff to discuss and share differing attitudes, values and beliefs and arrive at agreed and consistent approaches

The Process of Drawing up Guidelines

Suggestions:

1. Establish a working party - make up flexible (school staff with different remits / residential staff / medical & or therapists)
2. Allocate responsibilities / draw up timetable
3. Use questionnaire for staff related to different PSD themes - analyse results (example in Sex in Context)
   and/or
4. Audit present teaching programmes to provide a list of practical issues where guidance is needed
5. Discuss points raised/dilemmas at a meeting of the whole school staff/parents to open up discussion of sensitive and difficult areas as an 'ice breaker' for further work - a facilitator might be used with experience in this field (useful focus activities in Sex in Context)
6. Working party produces draft guidelines for consultation, amendment and agreement by whole school staff/School Board or equivalent and parents
7. Review and finalise recommendations for staff development.

Suggestions for Themes for Inclusion in Guidelines

• Content, methods and approaches used for learning and teaching PSD.
• Health Education in Scottish Schools : Meeting Special Educational Needs
• Learning opportunities and ideas for related activities at 3 stages (related to level of understanding, skills and choice and decision making abilities) with 'menu' approach and linked to Healthy & Safe Living attainment outcome 5-14 Environmental Studies
• 'Looking After Oneself' - body awareness; self awareness; choice; personal care; health awareness; growth & development
• 'Relationships' - cooperation & interaction; personal safety
• 'Health & Safety in the Environment' - physical safety; appreciating & exploring the environment

Sex in Context

Includes a core session plan, and other session plans and ideas for other activities on the themes of:

• Self Image, Self Esteem, Self Identity
  (gender; physical boundaries - me/not me; aromatherapy & massage; private parts of the body)
• Keeping & Feeling Safe & Healthy
  (likes/dislikes; choices; controlling the environment through actions - e.g. switches; activities to promote well being - e.g. massage, footspa, passive movements; vibrating mattress)
• Relationships with Others & Social Opportunities
  (being part of a group/different groups; sensory experiences related to different countries & cultures; greetings with other people)
• Feelings & Emotions
  (use of themes; theme room; drama, music & other sensory stimuli; special and everyday events to create moods/evoke responses and preferences)
• Physical/Sexual Development
  (naming parts of the body & bodily functions in the context of intimate care; use of agreed & carefully chosen language, objects of reference, signs; demonstrating public & private places through drama)
• Appearance / Self Presentation
  (personal care - experience of different toiletries & preferences; hand massage; compliments on appearance; dressing skills)

Methods and Approaches

• Active length - related to meaningful experiences in which pupils participate and gain knowledge and skills through practice
• Emphasis on sensory modesin learning and teaching
• Use of objects of reference and adapted signs to signal intent and encourage anticipation and understanding
• Intensive interaction
• Developing interpersonal skills through experiencing and taking part in a group (watching, listening, attending to others, taking turns, responding, copying, choosing)
• Use of intimate care as a teaching context which is accorded high status
• Careful observation, recording and discussion re interpretation of pupils' signs of communication
• Demonstration of appropriate attitudes/models of behaviour by staff
• Attention to age appropriateness of activities/resources
• Specific sessions within a PSD prograrme with a core structure
• Cross curricular links eg thematic; PE; Music; Language & Communication; Community experiences

Personal Relationships and Sexuality - Some Examples of Themes which might be included in Guidelines agreement about vocabulary and signs to be used (among staff with pupils)

• teaching about privacy and modesty - facilities for staffing (toileting, showering, changing)
• giving pupils time alone/least intrusive supervision
• physical contact/touch/greetings - between staff and pupils (also outwith school - escorts / general public) and between pupils
• age appropriateness - consideration of stage of development also careful choice of resources to reflect adult status
• use of non functional touch/therapeutic programmes - intensive interaction; massage; hydrotherapy/swimming; riding; multi-sensory environment; PE activities (request permission to touch whenever possible)

sexual arousal

• acknowledgment of sexuality/sexual feeling
• discontinue activity until arousal subsides

Q - is it in an acceptable context? eg; at changing time - can the person be given some 'time alone'?
if not - is the activity/its presentation/staffing appropriate?

masturbation - normal sexual behaviour but which needs to take place in appropriate surroundings, that is, a private place

when occurring inappropriately - records and discussion of possible reasons and resolutions -

• ill-fitting clothing?
• hygiene problem/medical reason?
• allergy?
• boredom or attention seeking?
• avoidance?
• lack of clear boundaries?

In cases where inappropriate masturbation seems to related to inability to reach orgasm, medical advice should be sought.

Examples of positive approaches to intimate care

- which ensures a Safe and Comfortable Experience for the Child

• Get to know the Child beforehand in other contexts to gain an appreciation of his/her moods and verbal and non verbal communication.
• Speak to the child personally by name so that he/she is aware of being the focus of the activity.
• Give explanations of what is happening in a straightforward and reassuring way.
• Enable the child to be prepared for and to anticipate events whilst demonstrating respect for his/her body eg by giving a strong sensory clue such as using a sponge or pad to signal intention to wash or change.
• When washing, always use a sponge or flannel and where possible encourage the child to attempt to wash private parts of the body him/herself.
• Provide facilities which afford privacy and modesty eg separate toileting and changing for boys and girls or at least adequate screening; bathing/changing children one at a time.
• Respect a child's preference for a particular carer and sequence of care.
• Keep records which note responses to intimate care and any changes in behaviour
• Agree appropriate terminology for private parts of the body and functions to be used by staff and encourage children to use these terms as appropriate.
• Speak to older children in a way that reflects their age.

Staff should receive training in good working practices which comply with health and safety regulations such as the wearing of rubber gloves for certain procedures and methods for dealing with body fluid spillages and manual handling.

• There should be sufficient space, heating and ventilation to ensure the child's safety and comfort.
• More than one member of staff should be available if a child is difficult to move or handle.
• Hoists should be provided for staff moving heavier children.
• There should be a suitable changing table.
• There should be a disabled toilet and/or appropriate toilet seats for children who require them.
• Items of protective clothing, such as gloves and disposable aprons, should be provided readily accessible.
• Special bins should be provided for the disposal of wet or soiled pads.
• There should be special arrangements for the disposal of any contaminated waste/clinical materials eg through the Schools Medical Service.
• Supplies of suitable cleaning materials should be provided for cleaning and disinfecting changing surfaces.
• Supplies of fresh clothes should be easily to hand so that the child is not left unattended whilst they are found.
• Checks should be made beforehand to ensure that there are suitable facilities for intimate care available on excursions and residential experiences.

• Are parents informed and consulted about arrangements for intimate care?
• Are staff familiar with child protection guidelines and procedures?
• Do staff know who to turn to for advice if they feel unsure or uncomfortable about a particular situation?
• Are any allegations which a child may make left unchallenged or unrecorded?
• Is inappropriate touching of any kind by staff or children allowed in games, horseplay, tickling?
• Are there guidelines as to the tasks which qualified and unqualified staff should undertake?
• Are students or volunteers involved in intimate care? Is this appropriate and, if so, are they supervised by qualified staff?
• How are decisions about the gender of the carer for a particular child reached?
• Should a member of staff be atone with a child when intimate care is being given?

Policy and Guidelines Structure

1. Establishment's policy statement re PSD
2. Aims for learning and teaching linked to policy statement
3. Guidelines on particular themes
4. Arrangements for policy and guidelines to be monitored and reviewed - who/how/when?
5. Indication of staff training and development needs at induction and at the inservice stage (may be related to a review of current practice)
6. Agreed review system for each pupil and for keeping and updating individual records related to specific parts of the guidelines (might include IEP's/record of progress in PSD programme or related to specific guidelines theme/s)
7. Once policy & guidelines have been formulated there is a need to share them with other settings (pupils often have several - home/school/ residential/respite).
   If the people concerned do not share this information, or at least keep each other informed, progress towards establishing good practice and safeguards will only be partial!

Health Education in Scottish Schools: Meeting Special Educational Needs, Josephine Eales & Judith Watson, SOEID, 1994 ( lSBN 0 7480 070 1 )

On the Agenda, Lorna Scott and the Image in Action Team.

Sex education for young people with learning difficulties.
A practical guide to policy making , planning and working with young people in schools and colleges using drama and active learning methods. Published in 1994 by: Image in Action, Jackson's Lane Community Centre, Archway Road, London N6 JAA

Movement, Gesture and Sign Paula Greenhill, Mary Lee, Lindi Macmillan , RNIB, 1996 (ISBN 1 85878 068 3)

Sex in Context Caroline Downs, Ann Craft, Pavilion Publishing, 1997 ( ISBN 1 900600 60 9) (Pavilion Publishing: 8, St George's Place, Brighton, East Sussex BNl 4GB; Tel: 01273 623222 )

Setting up a personal and social development programme for children and adults with profound and multiple impairments. In three parts:
Safeguards in Systems: A Handbook Strategies for devising guidelines relating to the sexuality of children and adults with profound and multiple impairments.
Part I A ringbinder containing strategies for developing a programme and recommendations for teaching and learning.
Section 1 Thinking about and deciding content, the learning process and associated exercises.
Section 2 Preparing for sessions, using session plans and activities based on the themes of: Self image , self esteem and self identity; Keeping and feeling safe and healthy; Relationships with others and social opportunities; Feelings and emotions; Physical/sexual development and sexual activity; Appearance/self presentation
Part II Section 3 Staff development; Becoming more at ease with sexuality; looking at projection (assumptions about / interpretations of others' feelings); recognizing and sharing feelings and perceptions.
Section 4; Working with parents and carers, including ideas for workshops.