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

1
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

2
We are talking about.
3
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 socio-sexual relationships.
• Freedom from organic disorders, diseases and
  deficiencies that interfere with sexual and
  reproductive functions (WHO).

4
?? Sexuality
5

What is Sexuality ?
anatomy, physiology, biochemistry of sexual
response system
roles, identity and personality
sexual knowledge, beliefs, attitudes, values and
behaviour of individuals.
individual thoughts, feelings, behaviour and
relationships.
ethical, spiritual, and moral
6
Sex and sexuality
SEX
SEXUALITY
7
Family Peers Neighbours
School Dating Marriage Information
/ entertainment media Advertising
Ideals Religious Beliefs Moral opinions
actions Values
Cultural
Ethical
sexuality
Biological
Psychological
Emotions Experience Self-concept Motivation Learne
d attitude / behavior Expressiveness
Growth Development Physical Appearance Physiolog
ical changes / cycles Sexual arousal
response Reproduction Fertility Control
8
Challenges to talking about sexuality

• Sexuality taboo topic per se
• Parents
• Teachers
• CBR workers
• Health care providers
• Delivering information specificity of
  disabilities

9
Who are we
talking about ?
10
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

11
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)

• .

12
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
13
Contents of module

• A training module has been developed and covers
  both teaching of
• life skills
• sexual health

14
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

15
When to teach

• AGE APPROPRIATE
• ABILITY TO UNDERSTAND
• Ikut umur mental? Ikut umur kronologi?
• Physical mental sexual growth.

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
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

21
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




22
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)





23
How to teach? Public and private body parts,
places and activities / behaviour

• Places
• Behaviour
• Talk

24
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.

25
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






26
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. Unders
tanding 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.
27
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 Disgu
st Surprise
28
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.
29
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

30
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

31
Feelings and Emotions

• USE FLASH CARDS
• PLAY GAMES feelings dice
• MAKING FACES
• Role play .. what if..
• Perlu Kaitkan
• Perasaan dengan situasi
• Perasaan dengan orang

32
Relationships How to approach and be approached
by others

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

Social Distance
33
PUBLIC
PUBLIC red no touch
STRANGERS
ACQUAINTANCE
STRANGERS orange wave
FRIENDS
ACQUAINTANCE Yellow Handshake
ME
FAMILY, SIBLINGS, PARENT
FRIENDS Green Faraway Hug
FAMILY, SIBLINGS, PARENT BLUE HUG
34
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.

35
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

36
PUBLIC
PUBLIC red no touch
STRANGERS
ACQUAINTANCE
STRANGERS orange wave
FRIENDS
ACQUAINTANCE Yellow Handshake
ME
FAMILY, SIBLINGS, PARENT
FRIENDS Green Faraway Hug
FAMILY, SIBLINGS, PARENT BLUE HUG
37
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.
38
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

39
Touch OK Not OK touches
What is good and bad touch. Types of touch
Cubit, cucuk-cucuk, pukul-pukul manja, stroking,
etc.
40
ABUSE PREVENTION NO, GO, TELL
SAFETY RULES ABOUT TOUCHING, especially our
private body parts

NEVER keep a SECRET about a TOUCHING problem.
41
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

42
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  
43
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

44
Mengajar di sekolah

• Kurikulum pendidikan khas
• Urus diri all compenent ada. Ada body 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

45
Are we ready
Ready or not , problem is out there
We need to take it ONE STEP AT A TIME
46
ADA SOALAN?

• GOOD LUCK