Accessible Mental Health Services

Accessible mental health services can be a challenge for people with disabilities, as there can be a lack of specialized provider training and difficulties with financial costs. We are defining accessibility in terms of disability and financial costs. This post provides a few mental health services for people with disabilities, with some services offering in-person services and others offering both in-person and online services.

Envision Unlimited

Mission Statement: “Envision Unlimited is a certified Community Mental Health Provider offering a full complement of behavioral health services to people with a variety of mental health concerns. We are committed to assisting clients in their best and meaningful lives.”

  • Offers outpatient therapy services to adults and adolescents, both in person and via telehealth
  • Based in Chicago, Illinois

Envision Unlimited emphasizes that no one will be denied access to services due to an inability to pay, and a discount is available.

There is also a program called ENVISION MORE for people with disabilities.

Title: ENVISION MORE. Year-long campaign to promote greater choice, independence, and inclusion for individuals with disabilities and mental health challenges. Provides comprehensive, high-quality services to help members "Envision More" of what they want in life. Box 1: More Ways to Thrive; Specialized programs like art-making, exploring nature, recovery-focused services, and cooking classes. Box 2: More Choice; Increased autonomy over daily life, such as personal living arrangements, community engagement, and hobbies. Box 3: More Independence and Inclusion; Assists members in becoming active participants in their communities. Box 4: More Support Services; Full spectrum of care on the community level, and includes day programs, employment services, mental health services, and specialized foster care. The logo for Envision Unlimited is in the upper right-hand corner.

NYSTART (New York Systemic, Therapeutic, Assessment Resources and Treatment)/CSIDD (Crisis Services for Individuals with Intellectual and/or Developmental Disabilities)

Goal: “…to build relationships and support across service systems to help people remain in their homes and communities and enhance the ability of the community to support them.”

  • Offers crisis prevention and response services to people who have both developmental disabilities and complex behavioral needs, as well as to their families and those who provide supports
  • Services are available 24 hours a day, 7 days a week to OPWDD (The New York State Office for People with Developmental Disabilities) eligible individuals age 6 and over who meet NYSTART/CSIDD eligibility
  • Based in New York, must be a New York resident 

The Arc

The Arc company logo.

Mission Statement: “Promoting and protecting the human rights of people with intellectual and developmental disabilities and actively supporting their full inclusion and participation in the community throughout their lifetimes.”

Delaware Disability Resources and Advocacy Organizations

  • All of the following services are based in Delaware

NAMI (National Alliance on Mental Illness)

Mission Statement: “NAMI Delaware supports, educates, and advocates for an improved quality of life for individuals and families affected by mental health conditions.”

  • Offers a variety of signature programs, an annual education conference, and special events (for individuals, families, and professionals to receive support and information)
  • Shapes public policy, has a toll-free NAMI Delaware Helpline, and works with media, educators, healthcare professionals, and elected and appointed officials (to raise awareness, fight stigma, and encourage understanding)
  • This link is for Delaware’s NAMI program, however, there are more than 650 NAMI State Organizations and Affiliates across the country

Division of Substance Abuse and Mental Health

Mission Statement: “To improve the quality of life for Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.”

  • Offers help for mental health issues (in which all services are free, and any referrals are available regardless of insurance), support groups and one-on-one counseling, suicide prevention resources, and other additional resources. 

Mental Health Association in Delaware

Mission Statement: “The Mental Health Association in Delaware strives to strengthen knowledge, resources and support around mental health and recovery.”

  • Offers education, support, and advocacy
  • Support: Offers wellness groups (one is a disability & chronic illness haven wellness group), mental health screening, and a peer support program with the mental health court (mental health court is available for people who have been charged with crimes because of a behavioral health disorder)

Learning from Temple Grandin

I had the honor of presenting at the Champaign-Urbana Autism Conference where Temple Grandin was the key note speaker. So much of her message could be applied to human sexuality instruction.

  • Don’t yell “no!” Calmly tell people what they should be doing. (Dr. Grandin was talking about putting her finger in her water cup at the dinner table, but the same rule applies to masturbation).
  • Give lots and lots of examples of what falls within a category and it will eventually build up the concept you are working on. (Dr. Grandin was talking about understanding church steeples but the same strategy can be used to understand body parts).
  • Once you have a concept down use that concept to expand. (Dr. Grandin was talking about airplanes, but the same principle applies to privacy – one you get private body parts down you can use the concept of privacy to understand places and ideas).
  • And from Eustacia Cutler (Dr. Grandin’s mother), “The more we understand how autism [and sexuality] works the less anxious we become.” And sexuality added.

I focused on goals for sexuality instruction across the lifespan (exploring, understanding boundaries, coping with changes, and living your story) as well as modalities for instruction (socialization, formal lessons, behavior planning, and advocacy).  You can find my presentation here.

 

8 Week Middle School Human Sexuality Curriculum

Over the summer, I did a 8 week sexuality class with middle school students with autism (3 boys and 3 girls).  I’ve posted each lesson from the curriculum, but I thought I’d link all the posts together so you could get to them in one place.  For each session there is a lesson plan, parent letter, and power point slides.  Some lessons also have worksheets.  I’ve also commented about how the lessons went and some ideas for adaptation.  Click on the links below to go to the posts and access the materials.

Human Sexuality 101 topic

*We sent home a workbook with follow up/supplemental material during this lesson.  The workbook is available on the post.

High School Human Sexuality 101 Week 1: Welcome

This summer, at TAP in Urbana-Champaign, we are doing an eight week human sexuality group for middle school students.  We have three boys and three girls in our group who range in age throughout the middle school years (from starting 6th grade to finishing 8th grade).   Check out the slides that accompany the lesson.

Our first week was a blast.  You can check out the full curriculum here [Sex Ed week 1].  We used a worksheet to help the students come up with their own definition of human sexuality.  I love the definition we came up with as a group, “Sometimes human sexuality topics make us feel uncomfortable, but it’s a part of life, specifically, part of our private life.  Human sexuality is about how we feel about people like loving someone and liking someone, but sometimes two people’s feelings may not match with each other. Human sexuality has to do with emotions, the body, and relationships.”

We sent a letter home with parents that explained the activities with fairly significant detail, touched on next weeks activities, and provided additional resources.  One of the important parts of this letter was suggestions for ways to incorporate these topics at home.  This week, as it was mostly about introductions, the parent component focused on using the rights and responsibilities at home.

Human Sexuality and Disability

asdsexed840Individuals with physical, cognitive, or emotional disabilities have a right to education about sexuality, sexual health care, and opportunities for socializing and sexual expression. Healthcare workers and other caregivers must receive comprehensive sexuality education, as well as training in understanding and supporting sexual development, behavior, and related healthcare for individuals with disabilities. The policies and procedures of social agencies and healthcare delivery systems should ensure that services and benefits are provided to all persons without discrimination because of disability.

Human sexuality encompasses the sexual knowledge, beliefs, attitudes, values, and behaviors of individuals. Its various dimensions involve the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships. Sexuality is influenced by ethical, spiritual, cultural, and moral concerns. All persons are sexual, in the broadest sense of the word.

From Sexuality Information & Education Council of the US, www.siecus.org

Tools for Teaching Human Sexuality

Teaching human sexuality is about formal lessons, selecting information, and choosing how to teach it, but it’s more than that.  To be a sexuality educator you have to see the whole person and be committed to support that person.  It’s not easy, it won’t be prefect, and you might make mistakes.  But it’s not impossible either and you have lots of tools.

To me, it’s about asking “why not?”.  Why not teach someone about different sexual positions?  Why not incorporate questions about sexual life into annual planning meetings?  Why not teach someone how to ask someone else on a date?  Why not affirm someone when they are expressing their sexuality?  Sometimes there are good answers to these questions but a lot of times there just aren’t.  Being a sexuality educator is about being an advocate.  It’s about giving people information in an engaging way they can digest.  It’s about teaching skills and changing patterns of behavior.  It’s about sending the message that there is nothing fundamentally wrong with who you are.  I really appreciate people taking time to read this blog because I think the work you do is really important.  Thank you!

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Music- A Different Way to Teach Sex Ed

Songs for Your Body is a curriculum comprised of, you guessed it, songs.   They cover hygiene, abuse, masturbation, contraception, sexually transmitted infections, and sexual health.  You can preview the songs on their website- I liked the masturbation songs.  In general, they’re a little hokey but I think it’s a good example of thinking outside the box.  The CD is $15.41 including shipping and handling and comes with a booklet of lyrics and activities.

Program Development Associates Online Store

This online store features 33 dvd based resources for teaching human sexuality to individuals with intellectual disability.  They have resources for…

  • All age ranges
  • Boys and girls
  • Nurses
  • Advocates

Prices range from $35.00 to $250.00 with everything in between.  This could be a great place to find what you need.

Dave Hingsburger- Blogger, Advocate, Educator

For those you how enjoy following blogs, and especially for those of you who enjoy blogs that feature individuals with disabilities, and particularly if you would like to read more about disability and sexuality- this blog is for you.

Dave Hingsburger is behind many of the resources from Diverse City Press such as Handmade Love/Finger Tips (masturbation education), No How (abuse prevention), and Undercover Dick (condom use).  He also has written several books such as The Key (supporting individuals with disabilities who are also sexual offenders), R: The R Word (bullying self-advocacy), and Just Say Know (victimization).  This is not an exhaustive list, but it gives you an idea.

Enjoy!

Parent Newsletters and Research about Sexual Behavior and DD

This series of parent news letters is available in English and Spanish.  They provide guidelines for families in regards to talking about sexuality topics.  They are not adapted for children with special needs, but I thought they could be useful regardless (especially the more general issues).  On this page the also have a fact sheet (English only) that has a lot of data about teens sexual behavior.  There is very little (almost no) information about the sexual behavior of adolescents or adults with developmental disabilities but I’ve summarized the research that is available below.   (You would need access to an academic library to read the full articles cited below for free).  Despite the limited research, most people (be they parents or professionals) come to my workshop because they already know people with disabilities have sexual intersts!

There have been several studies that suggest that individuals with ASD have a desire for intimate relationships (Henault & Attwood, 2002; Van Bourgondien, Reichle, & Palmer, 1997; Ousley & Mesibov, 1991). These studies may define “interest” as instances of sexual behavior.  For example, one study that reports the majority of 89 individuals with ASD living in group homes in North Carolina displayed some sort of sexual behavior (Van Bourgondien, Reichle, & Palmer, 1997).  Other studies define “interest” as self-reports of sexual activity and knowledge (Ousley & Mesibov, 1991). In both cases they are reacting to earlier studies that reported that individuals with ASD (and other disabilities) had no interest for intimate relationships with others (Despert,1971; Rumsey, Rapoport, Sceery,1985) and common myths that report individuals with ASD to be asexual (Irvine, 2005).

Despite the trend to move toward a more accepting view of sexual interest among individuals with ASD and other developmental disabilities, there remain questions as to what extent individuals with disabilities are interested in sexual activity. For example, most studies look at sexual behavior however individuals may be interested in intimate relationships even if they are not displaying sexual behavior. Some studies have shown that individuals with more knowledge are less likely to want to engage in sexual activity (Konstantareas & Lunsky,1997); however it seems that the relationship between access to sexuality education and the desire for support with relationship development remains unclear.

Sexuality Education Policy- An Example

I know many of you are interested in writing a sexuality policy for your agency to help guide decisions around teaching human sexuality.  Here is an example I thought might be helpful from Florida’s disability council.

What I really like about this policy is that they organized it around student responsibilities and educator responsibilities.  I think this is a nice model for conceptualizing a sexuality policy.  Below, I’ve highlighted the “Quick Reference Fact Sheet on Choice and Education Instruction” which is part of the policy.

Free Curriculum and Parent Resources

A lot of the curriculum we used for the puberty unit of our Human Sexuality 101 group was adapted from “Teaching Sexual Health“.  They are a group out of Canada that provides support for teachers and parents.  I used their general curriculum but they also have a curriculum for students of differing ability levels.  They have great resources for parents including “webisodes” that give examples of parents talking to kids about sexuality topics.  The website is very well organized and easy to use!

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Sex Ed in the News

ABC just did an article about teaching human sexuality to students with intellectual disability.  They focus on a New York school that has incorporated teaching sexuality into their mission.  One of my favorite lines from the article is that “Sex ed is not a goal, but a process.”  They mention in the article that New York City schools mandate sexuality education and I just wanted to comment on this, based on my experience in Illinois.

Although there is not specific information that addresses the willingness of school administrations to offer comprehensive sexuality education to individuals with ASD, there is information available for offering this type of education in general.  As part of the Affordable Health Care Act federal funding was opened up for comprehensive sexuality education called PREP- Personal Responsibility Education Program as well as Title V- abstinence only education meaning that states get to choose the type of sexuality education offered and may offer both (SIECUS, n.d.).  For fiscal year 2010, 43 states applied for PREP funding which means their sexuality education must cover abstinence, contraception use, healthy relationships, adolescent development, finical responsibility, educational and career success, and healthy life.  Until PREP funding was aproved funding was only available for Title V abstinence only education.

Even if comprehensive sexuality education is being offered in the schools, that does not mean it is being offered to individuals with disabilities.  Under the Individuals with Disabilities Education Act, students with Individual Education Plans have access to adapted general education curriculum.  At this point, my understanding is that, in Illinois this means a student can participate in a general education sexuality class room unsupported, with an aide, or opt out.  If the student (or more accurately, the student’s guardian), opts out, then the child’s special educator is required to adapt the curriculum with parental permission.  There are no standards for what that adaptation must cover.  Teachers may be working with professionally developed curriculum for individuals with disabilities, independently adapting a general education curriculum, or may be creating their own curriculum from scratch.  Due to the diverse needs and strengths among individuals with students with disabilities there may be great variability in how long it takes to cover various topics, to what depth topics can be covered, and what further adaptations may be needed.

Autism Now- A Resource

Autism Now isn’t specifically focused on topics related to sexuality but they do have some great resources I thought I could highlight.

They have a series of webinars related to sexuality topics. If you click on the link you’ll be taken to a registration box that you have to fill out to view the material.  I’ve also included links to the slides- this is a direct link, you don’t need to register.

Slides:  “Sex is when people use their bodies together to share love and pleasure.”

Slides: “Research says that the IQ has to be below 50 before you can say IQ and parenting skill are connected (Feldman& Tymchuk, 2002).”

And they just had one on May 15th, but you’ll have to keep an eye on the archive list because it’s not up yet-  “Let’s Talk About Sex: Discussing the Topics of Sex, Protection, and/or Sexuality from Three Unique Viewpoints”

In addition to the webinars they have some general “fact sheet” style info that might be helpful on topics such as dating, marriage, divorce, relationships, sexuality, parenting, and friendships.  These include general information as well as parent tips.

I was really impressed by the quality and quantity of ASD related resources on a variety of topics so it’s a good one to have in your tool belt.

I just wanted to link to one other power point presentation that I thought had a lot of good information.  “Sexuality & Sexuality Instruction with Learners with Autism Spectrum Disorders and Other Developmental Disabilities” by Peter F. Gerhardt, Ed.D., Director The McCarton Upper School