Margaret Cohen's Project

Introduction

Schools often leave the work of educating students with disabilities to social workers (Wilkenfeld & Ballan, 2011). Thus, an understanding of the needs of these social workers who function as educators, caregivers, or community advocates, is vital to the implementation of effective sex education. This paper explores the current research that exists on the intersection of social work and sexuality education for students with disabilities. This is analyzed through the attitudes and beliefs of school social workers. This lens offers implications for future research and suggestions for tangible organizational changes for providers to better serve students. While there is little research available on the work of social workers in regard to this issue, conclusions on their needs and the needs of providers can be made based on the available research.

There is a severe lack of research on the needs of students with disabilities in receiving effective sex education. This is noted in most literary reviews of the field. Even less well researched, however, is the role that social work plays in delivering such education. Social workers are, in some ways, there to fill in the gaps for resources that aren’t available. Teachers and parents often state that they are undereducated in sex education or that they feel they don’t have a responsibility to teach sex education, often referring to each other as the main provider. As a consequence, students are left with improper support and gaps in their knowledge of sexuality education (McDaniels & Fleming, 2016).

Improving sexuality education is especially relevant given the nature of the community of students these social workers serve. Students with disabilities are more vulnerable than their typically developing peers for sexual abuse (Gil-Lario et al., 2018). The vulnerability of this population makes effective intervention even more important, thus social workers must be readily equipped and supported to do so. While vulnerability to abuse is the reason most frequently cited for the need for sex education for this population, it is important to note it is not the only reason, as people with disabilities are individuals capable and deserving of healthy intimate relationships.

This paper seeks to summarize the research surrounding the role of social workers in securing sexuality education for students with disabilities. Four themes emerge from the current body of research, each relating to the attitudes and beliefs of social workers towards sexuality education for students with disabilities. These themes highlight areas of research that should be explored in the pursuit of comprehensive sexuality education for this population.

The role of social workers through the lens of their attitudes and beliefs

School social workers are trained mental health professionals who can assist with mental health concerns, behavioral concerns, academic, and classroom support, consultation with teachers, parents, and administrators as well as provide individual and group counseling. Overall, there is limited research regarding the multiple roles of school-based social workers. This is especially true in the area of sexuality education. Some of this may be due to social workers filling many roles around students learning sexuality education, including advocates for students and families, liaisons between support persons, and educators.

Whether it be special education teachers, parents, guidance counselors, care givers, health instructors, nurses, or social workers, the attitudes and beliefs of these providers affect the education offered to students with disabilities, how and when it is provided, and if it is provided at all (Lofgren-Martenson, 2004; Wilkenfeld & Ballan, 2011). As such, it is vital for providers to be aware of their attitudes and beliefs and address them. Research regarding these beliefs seeks to identify potential barriers to education for students with disabilities such as myths surrounding the sexuality of students with disabilities (Curtiss, 2018). This research can also identify potential strengths of the providers, such as a person-centered approach (McDaniels & Fleming, 2016).

It is important to identify where and how attitudes and beliefs influence the work of social workers because they can be changed or set aside to be more objective and better educate students with disabilities on sexuality. Using this lens to examine current research is useful in better highlighting the barriers social workers face and the strengths bring to providing sexuality education to students.

Themes in the available research

Theme 1: Role ambiguity and proscribed roles

The literature attempts to understand the roles of social workers in sexuality education for students with disabilities. A theme of ambiguity around the role for social workers, as well as other professionals, in the sexual development of students with disabilities was found (Bolin et al., 2017). There is clear involvement of social workers in the process, but it is not a well-defined role. It can range from being a person to talk to in crisis (Linton & Rueda, 2014), an advocate (Rueda et al., 2017), an educator (Bolin et al. 2017), and more. The ambiguity in roles is compounded when many professionals are working in collaboration with one another, and when the responsibility for guiding students through this content is left unclaimed (Rueda et al. 2017). This can result in opportunities for problematic behavior on the part of students (Rueda et al., 2017). One commonality across research surrounding the social work role is the dependency on social workers for education (Rueda et al., 2017) and resources (Linton & Rueda 2014) once a problem has already arisen.

One example of the role ambiguity is the use of social work roles from other types of social work: practitioner, enabler, advocate, broker, and manager in this application. Rueda et al. (2017) explain how each of these roles are fulfilled by social workers who work with students with disabilities on issues of sexuality and sexuality education. For example, the “practitioner” role refers to social workers doing any kind of counseling, while the “broker” role refers to social workers providing families with resources outside of the school setting (Rueda et al. 2017). Many times, multiple roles are fulfilled by one social worker as a function of the needs of the students’ situations and other resources available. One social worker filling many roles or many professionals filling the same role may act as a barrier to effective sexuality education by leaving work unclaimed or underemphasized. This may also affect attitudes and beliefs of social workers on sexuality education.

Theme 2: Institutional barriers

Another theme which emerges is the frequency with which organizational and institutional policies are considered obstacles to providing sexuality education for social workers (Bolin et al., 2017). Subsequently, it was stated that when this was cited by social workers, they described ways in which they would go around restrictive policies (Adams Rueda, Linton, & Williams, 2014). This may be a reason for the assumption that social workers are sympathetic to the argument for more inclusive and expansive sexuality education for students with disabilities.

An example of these barriers may be specific policies, such as abstinence-only policies, that prevent social workers from addressing the needs of young people with disabilities (Linton & Rueda, 2014). In a school setting that uses abstinence-only policies there may not be sexuality education available for students with or without disabilities who have a need for an education on the subject. This may be related to state or federal laws that restrict school curriculum on the subject of sex and sexuality (SIECUS, 2018). Social workers, however, have cited the NASW’s code of ethics as a reason to provide services regardless of such policies (Linton & Rueda 2014). In much of the available literature, there is the assumption that school social workers will be advocates for the need for sexuality education among students with disabilities.

The choice on the part of social workers to circumvent restrictive policies is sometimes based on the ethics that guide social workers. This suggests that social workers are sympathetic to the needs of young people, however, these attitudes are far from universal. It is also important to identify potential bias in the researchers’ attitudes and beliefs themselves surrounding the perception of social workers. There may be some level of confirmation bias at play when interviewing social workers about their ethics and ethical decisions.

Theme 3: Discomfort with the topic

Bolin et al. (2017) found a theme of social workers finding discomfort around the topic of sexuality education. This discomfort can act as a barrier to education for students with disabilities. Discomfort was cited coming from parents, teachers, social workers, and the community which results in fewer teachers teaching the subject or teaching to a limited extent. This discomfort extended to a fear of the reactions from stakeholders, with one social worker citing multiple lawsuits against a school district related to teaching sexuality content.

This discomfort may be emphasized when those who are in a guiding role don’t have the education themselves. Bolin et al. (2017) also cites discomfort from social workers in teaching certain aspects of sexuality. Sweifach and Laporte (2007) reported that social workers are shown to be more comfortable working on emotional and practical issues and less comfortable on physiological issues. This finding was not specific to social workers working with students with disabilities but generalized to social workers working with an unspecified population of students. However, it still suggests that this results in referrals to other individuals both within and outside of the school across population types (Bolin et al., 2017). It is interesting to note that while studying the attitudes towards sexuality education of specialists (e.g., special educators, social workers, nurses, and psychotherapists) working with individuals with disabilities, Parchomiuk (2012) found specialists are more likely to accept the socio-affective aspects of sexuality for people with physical disabilities, and more emphasis is put on the physical aspects for people with intellectual disabilities (Parchomiuk, 2012). For example, a stronger emphasis was placed on physical development and puberty over how to talk to a partner for people with intellectual disabilities. The difference in attitudes towards different populations could result in issues not being attended to for people with certain types of disabilities during the referral process.

The lack of education for social workers on the subject of sexuality education for students with disabilities may be a source of discomfort with the topic. This type of education, specific for social workers, is not well studied, but it is discussed or alluded to in the research that does exist on the intersection of social workers and sexuality education. Lee, Fenge, & Collins (2018) highlight the discrepancy between the acknowledged importance for social workers to be informed, and the severe lack of resources there are to inform them. Similarly, Areskoug-Josefsson, Rolander, & Bulow (2019) provide insight into the educational experiences of Swedish social work students surrounding sexual health. This study’s instrument does not include questions specifying for the sexuality of students with disabilities, but overall the study found that social work students were not prepared to address issues of sexual health with potential clients. These attitudes of unpreparedness may present as discomfort with the related topics.

An attitude of discomfort can stem from feeling unprepared but may also come from personal beliefs surrounding the topic of sexuality and sexuality for students with disabilities. Research encourages professionals to reflect on those beliefs as they have such a strong influence on the education provided to students (Curtiss 2018).

Theme 4: Unsustainable Referrals vs. Collaboration

One result of discomfort around the topic of sexuality is referring the job of sexuality education to other roles which are perceived as responsible or capable of filling the role of sexuality educator. This can look like social workers referring to nurses for educating on physiological changes (Bolin et al., 2017), social workers referring clients to outside specialists (Rueda, Linton, & Williams, 2014), or others referring to social workers for behavioral assessment or education related to sexuality (Rueda et al., 2017). This is likely related to the role ambiguity surrounding the logistics of sexuality education, and the comfort of the professionals working with students with disabilities.

Collaboration was cited as a tool used by social workers in providing sexuality education to students with disabilities. Frequent collaboration with teachers and counselors in and out of classrooms has been cited. Further work with outside specialists was also referred to by social workers with a collaborative and interdisciplinary view (Bolin et al., 2017). It is unclear in the research when and where referrals are considered collaborative, and when they are not. To this point, Bolin et al. (2017) makes a note of a theme titled “Role Deferral” which may provide some distinction between collaborative relationships and non-collaborative relationships, however it is not consistent throughout the literature (Bolin et al., 2017).

This ambiguity in referral and collaboration is a barrier to providing sexuality education for students. In the form of “role deferral” things are left unattended to in similar ways as described in the role ambiguity section. However, collaboration can be a strength for social workers working with this population. When done correctly it can include professionals, individuals with disabilities and parents which supports consistent practice and reinforcement of learning. The difference between role deferral, referral, and collaboration is likely related to the attitudes of social workers (and other professionals) towards their roles, abilities, education, and students with disabilities themselves.

Conclusions and implications for further research

The attitudes and beliefs of social workers highlight both barriers to sexuality education and the strengths of social workers in supporting the sexuality education process for students with disabilities. Current research which addresses attitudes and beliefs of school social workers highlights four important themes that relate to the attitudes and beliefs of social workers and how they function as barriers or supports to providing sexuality education. The theme of role ambiguity and proscribed roles describes the lack of clear place for school social workers which may allow for things to “fall through the cracks.” The theme of institutional barriers refers to ways in which social workers are affected by institutional policy, or other factors outside of their control which is most often cited as a barrier to providing education. Discomfort with the topic similarly did not serve as a factor that facilitated the education process. This theme suggested a lack of previous education and preparedness on the subject, and the influence of outsiders’ attitudes and beliefs on the social workers’ ability to provide education. Finally, the theme of unsustainable referrals vs. collaboration suggested that collaborative approaches can facilitate more individualization based on students’ needs but role deferral can be a deficit for students if their education is inconsistent.

These themes highlight the need for clarity in the roles of providers surrounding sexuality education for students with disabilities. Multiple providers have been shown to be involved in the process of educating students with disabilities, however collaboration wasn’t cited across all of the research. This offers an opportunity for research on effective collaboration and potential for prescribed roles to promote efficiency. Prescribed roles as a solution to decreased role ambiguity is just one option for structured collaboration between professionals and families for the education of young people with disabilities. There are still many remaining questions surrounding what collaboration between these roles looks like, is a necessary next step for the field.

Understanding the views of social workers on the topic of sexuality education for students with disabilities is important to understanding the role of social workers and the efficacy of their work. It’s clear that attitudes and beliefs influence their work, but it is unclear the extent to which it does and how common specific attitudes and beliefs are among social workers given the lack of research on the subject. This suggests that there are both external and internal factors that function as both barriers and strengths for social workers supporting the sexuality education process.

Additionally, there is a need for an interdisciplinary approach to research as the literature suggests such a high rate of interdependence of providers. This kind of research is important would reflect the interdisciplinary nature of the sexuality education process for this population. The attitudes and beliefs of teachers, parents, caregivers, counselors, etc. must also be considered from an interdisciplinary lens for further research to be effective.

Acknowledgements

I would like to thank Kate Doyle and Dr. Su-Je Cho for their guidance and support. This was completed with the support of the FCLC Dean’s Summer Research Grant.

Works Cited

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