English, Brad
(2018)
Consensus-based good practice guidelines for Clinical Psychologists to support care staff in enabling sexual expression in people with intellectual disabilities - a Delphi study.
DClinPsy thesis, University of Nottingham.
Abstract
Increasingly, society is acknowledging that people with intellectual disabilities (PWID) have sexual needs. This shift is reflected in international policy, with sexual expression acknowledged a basic human right for PWID. Staff that care for PWID have a responsibility to ensure this right is upheld. Though they generally report accepting views of PWID’s sexual expression, PWID report that their sexual expression is restricted by care staff. A lack of service-level policy regarding PWID’s sexual expression and how to support them in this, leaves care staff confused, and lacking confidence to make decisions about PWID’s care. Clinical Psychologists work with care staff who experience these difficulties. Though pockets of good practice are emerging, there is no guidance on how to best approach this work. This research sought to utilise the good practice already occurring.
We used the Delphi Method to develop a set of consensus-based good practice guidelines for Clinical Psychologists working with care staff around supporting PWID’s sexual expression. We conducted the Delphi across three rounds, with a panel of 17 Clinical Psychologists experienced in helping care staff support sexual expression in PWID. In Round One, the primary researcher interviewed panel members about clinical experiences and they each suggested three potential good practice guidelines. We then compiled the Round Two survey, in which all 51 suggested guidelines could be rated in terms of importance and sent it to all panel members. We developed the Round Three survey using the responses to Round Two, personalised to include information on how the 51 guidelines had been rated by the individual panel member and the panel as a whole. The Round Three survey gave panel members the option to amend their responses. Consensus that a guideline was important or essential (set at ≥90% agreement, a priori), meant it was included in the final set. We supplemented endorsed guidelines with vignettes based on the practice described in the Round One interviews.
The panel reached consensus that 12 guidelines were important or essential. These guidelines fell under four themes: ‘Addressing staff attitudes’, ‘Addressing uncertainty about rights and responsibilities of PWID’, ‘Locating the problem, being part of the solution’, and ‘Supporting care staff to understand and reflect upon their role’.
The limitations of this study include the homogenous sample and that the effectiveness of the practice Clinical Psychologists cited as evidence was not independently corroborated. This research provided insight into the important role Clinical Psychologists play in helping care staff support PWID’s sexual expression. Direct work with care staff to clarify their understanding of PWID’s rights, and to normalise and encourage reflection on the values care staff hold, were both considered central to the role. In addition, the panel suggested that Clinical Psychologists must put to use their unique professional skillset to share understanding about how organisational approaches are maintaining the gap between policy and practice, and what needs to be done about it.
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