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GUIDELINES ON ISSUES OF SEX AND SEXUALITY FOR

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GUIDELINES ON ISSUES OF SEX AND SEXUALITY FOR ...

    Appendix

    SEXUAL HEALTH

    POLICY,

    STRATEGY &

    GUIDELINES

    TO MEET THE SEXUAL HEALTH & HIV PREVENTION

    OBJECTIVES OF

    “THE NATIONAL STRATEGY FOR SEXUAL HEALTH &

    HIV” 2001

    January 2003

     Social Care, Housing and Health

     Directorate

    CONTENTS

     Page

    Policy Statement 3 Introduction 6 Strategic Objectives 9 Guidelines and Legislation 11 Protection 14 Personal and Sexual Relationships 17 Sexual Health 19 Contraception and Reproductive Health 20 Sex Education 26 Masturbation 28 Cross Dressing 30 Lesbian and Gay Identity Issues 31 Pornography and Sexually Explicit Material 33 Access To Sex Services 35 Staff Attitudes 36 Partnership with Parents and Carers 37 Equal Opportunities 39 Training 41 Confidentiality 42 Service Standards and Provision 43 Assessment and Care Planning 44

    Appendices Number

    Contacts and Resources (under development) 1 Bibliography 2

     1

    INFORMATION SHEET

All Teams Service area

January 2003 Date effective from

Policy document Service Planning Responsible officer(s)

    Manager

    Implementation - All Operational

    Managers January 2004 Date of review(s)

All Teams Target audience

    th28 January 2003 Date of committee/SMT decision

‘The National Strategy for Sexual Related document(s)

    Health and HIV’ Department of

    Health, June 2002

Sexual Health Policy, Strategy and Superseded document(s)

    Guidelines Cheshire County

    Council 1994

     File reference

     2

POLICY STATEMENT

    The need for a policy to govern our own social and personal relationships would be totally unacceptable to all of us. These relationships are a very important and private part of our lives. However, we all have rights and responsibilities in terms of how we conduct our social and personal relationships and we all act within some constraints, including being subject to current legislation.

    Service users may wish to continue or develop relationships, or be sexually active and have the same rights and responsibilities as any other member of society. Service users may however also need support with various aspects of their lives, including the development of social and personal relationships and matters relating to sexual health.

    In attempting to support service users in matters relating to their sexual health, staff will often feel they are intruding into private and sensitive areas of their lives. Staff will often be working with other staff, carers and adults with a range of needs who may hold differing views on social and personal relationships.

    Staff and carers may find themselves supporting service users with disabilities with sensitive issues and dilemmas regarding their relationships where there are no easy answers. Staff and carers will equally be concerned with balancing the rights of service users in order to develop social and personal relationships, whilst also protecting those who might be at risk of abuse and exploitation.

    The complex personal and ethical issues involved in the area of sexual heath dictate that a clear policy is required. Without such a policy staff may feel unsupported and vulnerable, which may in turn lead to unmet sexual health needs and the emergence of inconsistent practice across partner organisations.

    It is intended that this policy will benefit staff, service users and their carers by meeting their mutual interests. The policy endeavours to outline the balance between rights, responsibilities and risks in relation to social and personal relationships for staff, service users and their carers/relatives.

    As sexual health issues are common across all groups of people, throughout this policy reference is made to the term 'service user'. This term is used to represent an individual who may live with either a physical or sensory disability, mental illness, learning disability, substance dependence, or be someone who requires services as a result of an age related condition or serious illness.

     3

The Context for Social and Personal Relationships

    All service users have a need for social and personal relationships; the strength of that need and the manner in which this is expressed will be different for each service user.

    Whilst a number of service users may have frequent contact with people in both a familial and professional context, some individuals may not always be enabled the opportunity to develop relationships of a personal or sexual nature. A number of factors such as those involving negative attitudes, ignorance and a lack of privacy for those with support needs, may serve to compound such experiences.

    As with all members of society it is important for service users to be able to develop a range and variety of relationships. These relationships may therefore include social relationships with acquaintances and more permanent friendships. They may also include a range of sexual relationships including same sex relationships, marriage or cohabitation.

Recognising Rights and Responsibilities

    All service users, regardless of their age, disability, ethnicity, gender or sexual preference, have the same rights to freedom of choice as all other members of society.

    Implicit in this statement is the need to actively value the rights of all persons to freedom and choice. All staff must respect these rights, whilst at the same time ensuring that service users are fully aware of the possible consequences of their actions and not open to abuse or exploitation.

    The following is a set of guiding principles, which have already been tested and used within Personal Relationships Advisory Groups, to help address the problems faced by service providers and service users.

    ; Clients have the right to be treated with respect and dignity as individuals.

    ; Clients may wish to have opportunities for loving and being loved and to

    be helped to achieve fulfilling relationships; these will range from platonic

    friendships to partnerships, which include a mutually agreed sexual

    element.

    ; Clients have a right to receive input from staff that will help them to

    develop a positive self-image.

    ; Everyone has the right to represent their own moral, cultural and religious

    beliefs but nobody has the right to impose these beliefs on anyone else.

    ; Clients have the right of access to information designed to promote sexual

    health, including birth control and safer sex, parenthood and genetic

    counselling, within the limits of their own, and their staffs‟ ethical beliefs.

     4

    ; Service users have a legal right to expect confidentiality of personal

    information held by care agencies. Such information should only be

    disclosed with the consent of the service user, where required by order of

    the court, or where disclosure can be justified in the wider public interest.

    ; Service users have the right to form and develop personal relationships

    and to learn from such experiences.

    ; Service users have the right to seek further advice or follow the complaints

    procedure if they wish to raise a grievance.

    ; Service users and staff have an equal right to protection from abuse and

    exploitation: both have the right to say no.

    ; Community Care legislation requires individual needs to be assessed over

    a wide spectrum. Sexual health needs are an integral part of the overall

    health and well-being of service users and where appropriate should be

    addressed by service provision and reviews of care packages, etc.

    ; Service users have the right to the information and privacy necessary for

    the completeness of their sexuality.

    ; When requested, service users have a right to advice and counselling

    regarding physical and emotional needs, including relationships and

    differing sexual preferences.

    ; These rights apply to all people with disabilities, irrespective of where they

    live, the level of assistance required, or their sexual orientation. People

    have the right to maintain their sexual identity irrespective of the type of

    service or assistance required. It is clearly unhelpful to make assumptions

    about any aspects of another person‟s sexuality.

    ; In the delicate area of sexual health, there may at times be a tension

    between the needs of service users and staff. As attitudes to sexual

    issues are very individual, there is the potential for conflict, which both staff

    and those using services need to recognise.

    ; When attempting to address sexual health needs, all service providers

    and their staff need to be both aware of and protected from situations

    which may bring an organisation into disrepute, or prove to be illegal.

    ; Though carers and relatives do not have any legal rights over the affairs of

    a disabled adult, their influence will often be a crucial factor and needs to

    be acknowledged. Carers and relatives do however have some rights and

    expectations of their own which need to be taken into account.

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INTRODUCTION

    From the outset it is important to note that many service users will not require any intervention or response from staff concerning their sexual health. Staff are expected to use their discretion in relation to whether or not a service user would wish to discuss such a matter, or to decide where it may be legitimate to broach a particular issue with a service user (See 8. Masturbation). However,

    regardless of particular circumstances all services users and those responsible for their care, will benefit from guidelines, which outline roles and responsibilities in relation to sexual heath.

    This document is intended to support staff working with all service users, regardless of age, disability, ethnicity, gender or sexuality. It promotes a shared philosophy and value base, which underpins the rights, responsibilities and risks in relation to the promotion of sexual health.

    It should be noted that this policy is not designed to respond to situations where concerns or suspicions of abuse of a service user arise. In such circumstances, any necessary and appropriate response will be guided and informed by existing adult and child protection policies and procedures.

    This document has been developed as a collaborative project between the following agencies:

     Halton Borough Council Social Care, Housing and Health Directorate

     Warrington & Halton Primary Care Trusts Health Promotion Services

    Representatives from the following organisations supported the development of a learning disability and physical disability document from which this document has been produced:-

; Acorn Lifelong Learning Centre

    ; British Deaf Association

    ; Chester & Halton (NHS) Trust

    ; CIC

    ; Deafness Support Network

    ; Halton Borough Council

    ; Halton Disability Services

    ; Lifeways Community Care (Warrington)

    ; Neurological Rehabilitation Services

    ; North Cheshire Hospital Trust

    ; The Stroke Association

    ; Warrington Borough Council

    ; Warrington Community Health Care (NHS) Trust

    ; Warrington Community Living

    ; Warrington Disability Information Service

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     CONTEXT FOR SEXUAL HEALTH WORK

     Historically work with all service user groups has touched upon issues of ;

    sex, sexuality and personal relationships. However, due to the sensitive

    nature of such work, a wide variance in society's attitudes and a

    complex and confusing legal context, practice has differed widely, often

    leading to issues of sexual health often being disregarded.

     CONCLUSION

     Staff who's function is to assess need and provide the support ;

    necessary to enable service users to live independently, with dignity and

    respect, can only achieve this by fully embracing the need to promote

    sexual health for all service users.

     The requirements of legislation and the realities of the twenty-first ;

    century make it essential for care agencies to develop a comprehensive

    framework within which the sexual health needs of all service users can

    be addressed.

     To do this requires us to adopt a clear policy, a comprehensive strategy ;

    to implement this and guidelines to inform practice in each service area.

     The policy and strategy are also necessary in order to create the culture ;

    in which positive sexual health work can take place steered by the

    targets of the “National Strategy for Sexual Health and HIV” (DoH 2001)

    and “Human Rights Act” (2000).

Prepared by:

Geoff Holliday Mary Orrell

    Health Promotion Specialist Sexual Health Link Worker

    Sexual Health

October 2002

     7

This document is based upon the following source material:

    ; Learning Disabilities Sexual Health Policy, Strategy & Guidelines to Meet

    the Sexual Health & HIV Prevention Objectives of “The National Strategy

    for Sexual Health & HIV” 2001. Chester & Halton Trust Learning

    Disabilities Community Support Team (2002)

    ; Physical Disabilities Sexual Health Policy, Strategy & Guidelines to Meet

    the Sexual Health & HIV Prevention Objectives of “The National Strategy

    for Sexual Health & HIV” 2001. Chester & Halton Trust Learning

    Disabilities Community Support Team (2002)

    ; Cheshire County Council Social Services “Sexual Health Policy & Strategy

    to Meet HIV Prevention Objectives of Health of The Nation Report” (1994)

     8

    STRATEGIC OBJECTIVES RELATING TO SEXUAL

    HEALTH AND HIV PREVENTION

    The framework to address sexual health issues needs to be based on: -

     VALUES

     (a) Acceptance, respect and support for individuals‟ sexual

    expression and identity, provided that neither the individual nor

    others are coerced or adversely affected by someone‟s choice

    of sexual expression.

     (b) The understanding that service users need knowledge and the

    opportunity to develop skills to make healthier choices, which

    will protect them in the broadest sense.

     (c) These values must operate within Halton Borough Council‟s

    Equal Opportunities framework.

     (d) All service providers need to have an understanding of the law

    relating to sexual behaviour, and the rights of all service users

    to protection from abuse.

     PRINCIPLES

    Freedom Versus Protection

     (a) This policy recognises that sex and sexuality are a positive

     aspect of development for all human beings, and that people

     who use our services should be able to access the relevant

    advice and support to promote their physical, emotional and

    sexual health and well being.

     (b) In applying the policy, consideration has to be given to the

    dilemma, which may arise between the possibility of service

    users engaging in illegal activity and the need to provide advice,

    which may serve to protect service users from greater physical

    harm (e.g. sexually transmitted diseases including HIV).

     (c) Interventions must result in staff being able to distinguish

    between relationships, which are entered into on an informed

    equal basis, and those relationships, which are characterised by

    abuse of power or status.

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