The Birds, Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities

Abstract

Adolescents with intellectual disabilities (ID) represent an invisible at-risk population for multiple negative health outcomes. Much like their non-disabled peers, promoting healthy behaviors during adolescence has the potential to improve quality of life later on in life (McPherson et al. in J Appl Res Intellect Disabil 30(2):360, 2017). Many studies have analyzed disparities in obesity (Phillips et al. in Matern Child Health J 18(8):1964, 2014; Stancliffe et al. in Am J Intellect Dev Disabil 116(6):401, 2011), mental health (Charlot and Beasley in J Ment Health Res Intellect Disabil 6(2):74, 2013), and health care access (Baller and Barry in J Disabil Policy Stud 27(3):148, 2016), however sexual health needs further research and translation to practice. Access to sexual health education is limited for many youth with ID (Barnard-Brak et al. in Ment Retard 52(2):85–97, 2014). Studies have shown that students with ID experience higher rates of sexual abuse and assault than their non-disabled peers (Haydon et al. in J Interpers Violence 26(17):3476, 2011; Mahoney and Poling in J Dev Phys Disabil 23(4):369, 2011). Sexually active youth with ID are at a higher risk for contracting sexually transmitted infections compared to their non-disabled peers (Cheng and Udry in J Dev Phys Disabil 17(2):155–172, 2005; Mandell et al. in J School Health 78(7):382–388, 2008). Additional barriers exist including stigma and misperceptions around disability and sexuality and the assumption that the developmental status of the student will prevent sex education comprehension (Sinclair et al. in Educ Train Autism Dev Disabil 50(1):3–16, 2015). Qualitative studies of adult providers (Linton et al. in Sex Disabil 34(2):145–156, 2016; Murphy et al. in J Genet Couns 25(3):552, 2016), parents (Kok and Akyuz in Sex Disabil 33(2):157–174, 2015), and adolescents with ID (Lofgren-Martenson in Sex Disabil 30(2):209–225, 2012) have found overwhelming support for tailored sexual risk reduction interventions (Swango-Wilson in Sex Disabil 27(4):223, 2009). Developing evidence-based, inclusive curricula to prevent sexual coercion as well as promote sexual health self-determination for this vulnerable population is long overdue (McDaniels and Fleming in Sex Disabil 34(2):215, 2016). This study demonstrates the use of Universal Design for Learning (UDL), an educational framework, guidelines, and checklist tools (Eagleton, Universal Design for Learning (UDL), Salem Press, Ipswich, 2015; Center for Applied Special Technology, UDL curriculum self-check 2011 (updated 2011), 2011. http://udlselfcheck.cast.org/resources.php ) to increase accessibility in HIPTeens, an evidence-based sexual risk reduction intervention (Morrison-Beedy et al. in J Assoc Nurses AIDS Care 13(1):21–27, 2002; Res Nurs Health 28(1):3–15, 2005; AIDS Behav 10(5):541, 2006; J Assoc Nurses AIDS Care 21(2):153–161, 2010; West J Nurs Res 33(5):690–711, 2011; J Adolesc Health 52(3):314–321, 2013; J Assoc Nurses AIDS Care 28(6):877–887, 2017). As a result, supplemental curriculum components were developed with UDLguided technology use recommendations. A UDL-integrated evidence-based sexual risk reduction intervention could increase accessibility and, with additional research, could help inform inclusive policy.