Children With Special Needs And SRH: What We Need To Tell Them

Dr Faridah bt Abu Bakar Public Health Physician (Family Health) Family Health Development Unit Perak State Health Department

We are talking about.

What is Sexual Health

A capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic. Freedom from fear, shame and guilt, false beliefs, etc which inhibit sexual response and impair sociosexual relationships. Freedom from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functions (WHO).

?? Sexuality

What is Sexuality ?
anatomy, physiology, biochemistry of sexual response system;

roles, identity and personality

ethical, spiritual, and moral

sexual knowledge, beliefs, attitudes, values and behaviour of individuals.

individual thoughts, feelings, behaviour and relationships.

Sex and sexuality

SEX

SEXUALITY

Ideals Religious Beliefs Moral opinions & actions Values

Family Neighbours Dating Advertising

Peers School Marriage

Information / entertainment media

Ethical

Cultural

sexuality
Biological
Growth & Development

Psychological
Emotions Experience Self-concept Motivation Learned attitude / behavior Expressiveness

Physical Appearance
Physiological changes / cycles Sexual arousal & response

Reproduction
Fertility Control

Challenges to talking about sexuality

Sexuality taboo topic per se

Parents Teachers CBR workers Health care providers

Delivering information specificity of disabilities

Who are we talking about ?

Is there a problem?

Children with Disabilities grow into adulthood ill equipped

Sexual misconduct in schools Sexual health problems in institutions Problems at home & the community Sexual abuse, unwanted pregnancies

PWDs are not asexual

Children and youth with disability have a genuine need to learn about sexuality

Information Develop values (family, religion, cultural ) Develop interpersonal skills (communication, decision making, peer refusal skills, creating satisfying relationships) Develop responsibility (for their own bodies and actions)

TRAINING MODULE LIVE LIFE, STAY SAFE REPRODUCTIVE HEALTH FOR CHILDREN AND ADOLESCENTS WITH DISABILITIES

BY FAMILY HEALTH DEVELOPMENT DIVISION MINISTRY OF HEALTH, MALAYSIA

IN COLLABORATION WITH :

Contents of module

A training module has been developed and

covers both teaching of

life skills sexual health

What to Teach?

Public and private : body parts, places and activities / behaviour Bodies : Basic info needed for daily self care

Social Distance - Relationships : How to approach and be approached by others

Feelings and emotions: Difference of appropriate and inappropriate touch Safety plans : NO , GO, TELL

When to teach

AGE APPROPRIATE ABILITY TO UNDERSTAND

Ikut umur mental? Ikut umur kronologi?
Physical mental sexual growth.

3-9 years

10-15 years

16 and above

Body parts

Difference between boys and girls

Public and private body parts How babies are made simple terms, when opportunity arise Hygiene

Life cycle changes

Puberty- changes oPhysical oMental oEmotional

Your body is your responsibility

oDifference

between sex and love

How babies are made oResponsibilities of details sexual relationships

oResponsibilities

of

parenting Hygiene Masturbation Hygiene Masturbation

3-9 years

10-15 years

16 and above

Public and private

oPlaces oBehavior

Places

Behavior

Behavior othe way you correct when o the way you dress dress opportunity arise othe way you Conversation look at people oConversation o talk to people you correct when trust Conversation otalk to people opportunity arise you trust

3-9 years

10-15 years

16 and above

Feeling and basic skills in socialisation and emotions communication recognise & express emotion making friends

Building and maintaining relationships o people of same sex o people of opposite sex o the way you look/ talk at people

Building and maintaining relationships people of same sex people of opposite sex the way you look/ talk at people

3-9 years

10-15 years

16 and above

Relations hip and touch

RELATIONSHIP BOUNDRIES batas pergaulan Recognising different type of touch Saying no to inappropriate touch

RELATIONSHIP BOUNDRIES batas pergaulan between same sex and different sex

RELATIONSHIP BOUNDRIES batas pergaulan between same /different sex Recognising different type of touch Saying no to inappropriate touch

Recognising different type of touch

Saying no to inappropriate touch

Laws and Laws and consequences consequences of of inappropriate inappropriate touching others touching others

How to teach?

Break topics into smaller pieces Start with basics Be concrete use visual cues Be repetitive and cumulative Modify for specific disabilities Be comfortable with issues of sex and sex abuse Attending to disclosure

BE CREATIVE

How to teach? Public and private : body parts, places and activities / behaviour
BODY PARTS:- It is important that children with disabilities can identify, name and know the function of their body parts. They must know the parts that are private so as to ensure appropriate behavior and prevent abuse.
Use dolls, pictures, cards , magazines, Demonstrate , role play

Explain , explain, explain, then Ask to see if they understand

How to teach? Public and private : body parts, places and activities / behaviour

What is public or private is not clear to children. It has to be taught especially for children with special needs. They need to know public places and private places in the home as well as outside home. (Only when the door is closed is a room a private place including the toilet)

How to teach? Public and private : body parts, places and activities / behaviour

Places Behaviour Talk

How to teach? Public and private : body parts, places and activities / behaviour
Private self privacy family privacy Describe what can be done Self privacy - toilet, changing room, own room Family privacy only parents/carers in privacy e.g. pull a screen or ask other family members to leave Adab masuk bilik ibu bapa. Bilik orang lain Public In places other than the regular place of stay e.g. playground, school, bus station, shopping mall.

How to teach? Public and private : body parts, places and activities / behaviour
Use dolls, pictures, cards , magazines, Demonstrate , role play

Explain , explain, explain, then Ask to see if they understand

Feelings and Emotions

Children need to be taught to recognise and express emotions appropriately, as well as to respond appropriately to others expression of emotions. This is part of a persons basic skills in socialisation and communication. Understanding of the link between emotions and sexual health would help children and teens deal with their sexuality and handling their feelings to do with their sexual behaviour.

Feelings and Emotions

The basic feelings or emotions that children and adolescents need to understand emotions, cause of the emotion and be able to express : Happiness Sadness Anger Frustration Fear Disgust Surprise

Feelings and Emotions

Understanding Interpersonal Emotions Like /Dislike Hate/Rejected/Unwanted Understanding Physical Feelings: Feelings that are physical in nature include: Uncomfortable Relaxed Tired /Sleepy Painful It is useful to also teach children and adolescents to be aware of their emotions on a more behavioural and physiological level.

Feelings and Emotions

What happens in your body when you are [emotion]? Heart rate faster/slower Breathing rate faster/slower Muscle tension in various muscle groups Headache Butterflies in the stomach Ticklish feelings in the chest Heavy feelings in the chest Heart being gripped hard What do you DO when you are [emotion]? Cry Laugh Run Jump Freeze Clench my jaw Tighten my fist Shout / Scream Hit / Kick Throw objects

Feelings and Emotions

Need to teach on how to cope with emotions Distraction techniques Relaxation Redirection of behaviour Seek help Someone to talk to Someone for assistance different types of support esteem, resource, information, emotional, physical. Someone to help problem solve

Feelings and Emotions

USE FLASH CARDS PLAY GAMES feelings dice MAKING FACES Role play .. what if..

Perlu Kaitkan ; Perasaan dengan situasi

Perasaan dengan orang

Relationships : How to approach and be approached by others

Everyone has a place & personal space Social Distance Adapted the Circles concept we have omitted the cuddle circle
Discuss persons you can trust, things you can talk about

PUBLIC
PUBLIC red no touch STRANGERS STRANGERS orange wave ACQUAINTANCE FRIENDS

ACQUAINTANCE Yellow Handshake

ME

FRIENDS Green Faraway Hug

FAMILY, SIBLINGS, PARENT

FAMILY, SIBLINGS, PARENT BLUE HUG

Relationships : How to approach and be approached by others

Roles and relationships of the people in the social circles may vary with developmental or relationship changes. Parents need to demonstrate the different zones and the different reactions. The behavior towards the persons within the specific zones should be consistent.

Relationships : How to approach and be approached by others

What are relationships Types of relationships Limitation of relationships their roles, things you can talk about, identify person can you can go for help

Changes in roles and relationships will change the positions of the people within the circle

PUBLIC
PUBLIC red no touch STRANGERS STRANGERS orange wave ACQUAINTANCE FRIENDS

ACQUAINTANCE Yellow Handshake

ME

FRIENDS Green Faraway Hug

FAMILY, SIBLINGS, PARENT

FAMILY, SIBLINGS, PARENT BLUE HUG

Touch OK & Not OK touches

Children need to know about different types of touch. This knowledge alerts them when to tell someone about any confusing touch. Knowing the rules help children be aware of their rights and responsibilities.

Touch OK & Not OK touches

OK touch : Touching to attract attention - on shoulder, hand, arm Touching to comfort - pat on the back / shoulder, hug Accidental Touch - during games, public transport Not OK touch Saying NO to unwanted touch touch private parts pat on head sexy touch

Touch OK & Not OK touches

What is good and bad touch. Types of touch: Cubit, cucuk-cucuk, pukul-pukul manja, stroking, etc.

ABUSE PREVENTION NO, GO, TELL

SAFETY RULES ABOUT TOUCHING, especially our private body parts

NEVER keep a SECRET about a TOUCHING problem.

What is important for care givers to know

Ethics of Touch to / for care providers

Privacy, relationships, touch, affection, intimate & personal care

Abuse
emotional, physical & sexual abuse Risk factors, barriers to disclosure, effective prevention activities

Touch OK & Not OK touches

Touch Appropriate / Inappropriate for staff

Touch should be: contextual public touch physical space and distance
Touch is contextual : teaches circumstances for appropriate touch identifies what is happening understand motive protects staff from accusation

Touch OK & Not OK touches

Touch Ethics boundaries (privacy) for care givers and service providers People with disabilities have a reduced sense of boundaries privacy is learned invasion of privacy can be subtle privacy is a mental health issue not sexual issue application of privacy is a social skill

Mengajar di sekolah

Kurikulum pendidikan khas

1. Urus diri all compenent ada. Ada body 2.

part but not mentioned about about private body. Galakkan penggunaan CIRCLE no go tell. Kerohanian (moral and agama adab elemen use circle) Akedemik math, english, bm Seni

3. 4.

Are we ready
Ready or not , problem is out there

We need to take it ONE STEP AT A TIME

ADA SOALAN?

GOOD LUCK