Questions and Answers: Sexual Health Education for Youth with Physical Disabilities – What can I do?

What can I do to support the parents/caregivers of youth with physical disabilities?

Families and caregivers often play key roles in the daily functioning of youth with physical disabilities, particularly regarding their personal care.Footnote 60  Given their frequent and close contact, families and caregivers may also be important sources of sexual health information for these youth.Footnote 61

Families and caregivers are important allies in supporting school-aged youth with physical disabilities as sexual beings. However, educators and other professionals should be aware of confidentiality issues around the sexual health concerns of school-aged youth.

Before involving families or caregivers in the sexual health education of any youth, it is important to know how the youth feels about involving their parents or caregivers and to obtain their permission. Youth may perceive the school as a place where they can practice autonomy and independence. Educators should be aware of this and respect a youth's wishes based on age­appropriateness and individual circumstances.

Families and caregivers of youth with a physical disability often face many challenges. It is important to ensure that they are supported. Families and caregivers of school-aged youth with physical disabilities are often pulled in many directions, both emotionally and financially. They face many demands that can cause stress and strain on the family unit and on individual members. These may include:

  • Repeated visits to doctors;
  • Long-term hospital stays;
  • Missed work, change in work status, reduced work schedule;
  • Reduced time spent with friends or extended family;
  • Marital stress or relationship breakdown;
  • Long-distance travel to access services; and
  • Additional financial burdens for medical expenses, equipment and supplies.Footnote 62

Research has identified nine characteristics of resilience in families with children who have physical disabilities. They:

  • Balance the needs of a youth with a physical disability with other family needs;
  • Maintain clear family boundaries;
  • Develop communication competence;
  • Attribute positive meaning to the situation;
  • Maintain family flexibility;
  • Maintain a commitment to family as a unit;
  • Engage in active coping efforts;
  • Maintain social integration; and
  • Develop collaborative relationships with professionals.Footnote 63

Parents and caregivers can be supported by directing them to community resources and support groups to help them foster healthy sexual development in youth with physical disabilities.

Educating all parents may help establish an inclusive school environment for their children. For example, providing information on physical disability to all parents in the school will help them develop inclusive attitudes and values among all students.

All youth require support, acceptance, understanding and compassion from their families to transition through healthy development. Being aware of the challenges faced by families of school-aged youth with physical disabilities and providing them with access to resources that build resilience for both youth and family members will enable families to support the health and sexuality of their children.

How can I help to build the resilience of youth with physical disabilities?

Resilience requires a way of thinking or skills that enable people to be successful in a variety of circumstances. This can be related to sexual health but is not limited to it. This set of skills and approaches to problem solving establishes a range of protective factors against health-compromising behaviours or destructive coping strategies.

Resilience: The ability to positively cope and manage stress, and then to be able to "bounce back" to a previous state of normal functioning and incorporate adaptations for future situations.Footnote 64

Canadian research has identified the following key attributes in resilient youth:

  • Access to basic resources such as food, clothing, shelter, education and health services;
  • Access to supportive relationships with family, peers and community;
  • A strong personal identity, including a sense of purpose, aspirations and beliefs;
  • A strong internal sense of control and personal autonomy;
  • Adherence to cultural traditions, including adherence to cultural practice and values;
  • Acceptance and social equity in the community; and
  • A sense of cohesion with others; that is, feelings of belonging or a sense of social responsibility.Footnote 65

Educators and other professionals can do several key things to foster resilience in youth with physical disabilities:

  • Helping young people establish relationships with peers and role models can create networks of support for youth with physical disabilities and can lead to greater self-esteem and an increased sense of self-worth;
  • Providing environments that are respectful, that include healthy expectations and recognize the achievements of youth with physical disabilities can also lead to greater self-esteem and increased sense of self-worth;
  • Supporting a school environment that is fully accessible to youth with physical disabilities can provide them with increased opportunities to socialize with their peers, reduce the likelihood of social exclusion, and increase a sense of belonging for these youth. For example, this may include making communal washrooms, change rooms and showers accessible to youth with physical disabilities. If students with physical disabilities are regularly limited from participating with fellow students due to physical environmental limitations, they have limited opportunities to develop relationships with their peers. This in turn has a negative impact on their self-confidence, self-esteem and sense of self-worth;
  • Including discussions of disability and sexuality in sexual health education and making resources on disability and sexuality available in school libraries can increase understanding among youth, and can provide assurance to youth with physical disabilities that they are not alone. For example, educators should consider introducing books or other media into lesson plans which feature a youth with a disability in dating or sexual relationships, to address prejudices and myths about the sexuality of the physically disabled.

Youth with physical disabilities who have higher levels of self-esteem, acceptance of their disability and connectedness with family, school or community are more likely to be resilient and make healthy sexual decisions. Youth who do not have high self-esteem or a sense of belonging with peers are more likely to engage in high-risk behaviours, including substance abuse and risky sexual relationships.Footnote 66

By providing support systems and encouraging understanding and inclusion, schools have the capacity to build the resilience of school-aged youth with physical disabilities. Such support for these youth and their families will help them develop healthy sexualities and be better able to cope with their physical disabilities in a positive manner throughout their lifetime.

Concluding remarks

Educators and other professionals working with youth with physical disabilities have a responsibility to ensure that their rights and dignity are respected. Providing sexual health education inclusive of school-aged youth with physical disabilities is fundamental to their overall development and health. Evidenced-based strategies, such as those found in this document, can be used to create supportive environments for youth with physical disabilities and to foster discussions on disability and sexuality.

Failure to respond adequately to the educational, social, cultural and public health needs of school-aged youth with physical disabilities removes from them key supports and protective factors in their lives. It is important that youth feel safe and supported and that schools and communities address both their learning and their physical needs. It is equally important to create an environment where youth with physical disabilities can contribute, be engaged and be of service to others. Teachers, parents, caregivers and administrators working together can help these youth develop resilience, to be strong self-advocates and to make healthy choices that may increase their opportunities for a healthy, happy, productive and satisfying adulthood.

The Canadian Guidelines for Sexual Health Education (Guidelines) is a resource that educators, school administrators and health professionals can use to assess their own sexual health education programs and to plan and implement sexual health education that is inclusive of the needs of youth with physical disabilities. The Guidelines also provide guidance on how to monitor and evaluate these programs to ensure that they are accurate, current, evidence-based and non-judgmental.

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