Experiences with Pregnancy of Adolescents with Disabilities from the Perspectives of the School Social Workers Who Serve Them

Adolescents with disabilities are more likely than adolescents without disabilities to become pregnant, although very little is known about the lived contexts of their sexual and pregnancy experiences. Such youths are often deprived of sexual health information across a range of potential sources, although school social workers are in a unique position to provide them services. Thirteen school social workers working primarily with adolescents with disabilities were interviewed using a phenomenological study design to offer their perspectives concerning the sexual and pregnancy experiences of such youths. Inductive content analysis revealed that school social workers provided services for pregnant and parenting adolescents with a range of disabilities in areas that included making decisions about sex, deciphering whether they were pregnant, and making decisions once they were pregnant. These experiences were complicated by cognitive impairments; emotional struggles; desires to fit in with peers; histories of sexual abuse; and issues with communication, self-esteem, and impulsivity. School social workers play an integral role in preventing pregnancy and supporting adolescents with disabilities who are pregnant. Recommendations pertaining to the provision of sexual health services for adolescents with disabilities are provided

Grand Challenges in School Social Work: Collaboration and Constraint in School Social Workers’ Sexuality Support for Children with Disabilities

Children with disabilities (CWD) face challenges to the development of their sexuality, in part due to a lack of appropriate, tailored sexual education in schools, role ambiguity regarding provision of sexual health services, and widespread discomfort with the topic. However, CWD have unique sexual health needs, an increased vulnerability to sexual and other forms of violence, and desire for skills and knowledge to build relationships. Using a phenomenological lens, authors conducted semistructured interviews with eight school social workers to understand how they are working with other professionals to support sexual and relational health of CWD (ages three to 11). Results indicate that school social workers collaborated with other professionals, although they also described multiple contexts in which other professionals had sole responsibility for sexual education and deferred to their expertise. Role ambiguity, policy restrictions, proscribed roles, and discomfort with the topic limited provision of needed services. Findings can assist school social workers seeking to build interdisciplinary collaboration, reduce role ambiguity, foster comfortable environments, and advocate for appropriate formats to support the sexual and relational health and well-being of CWD. They also suggest areas for policy change so that sexual support services are inclusive of all youths

School Social Workers\u27 Needs in Supporting Adolescents with Disabilities toward Dating and Sexual Health: A Qualitative Study

School social workers approach their direct practice from ecological systems and justice-oriented perspectives. As such, they may hold a critical role in providing needed sexual health and dating education and services to adolescents with disabilities. Thirteen high school social workers who work closely with adolescents with disabilities were interviewed to identify their needs and challenges in supporting such adolescents toward dating and sexual health. Mesosystemic challenges at the school level evidenced three themes: (1) the desire for school-based comprehensive sexual education for all adolescents, (2) a multitiered and ancillary approach to educating adolescents with disabilities about dating and sexual health, and (3) increased time (that is, via additional funding) to provide social work services to adolescents with disabilities. Exosystemic needs and challenges were reflected in discussions about community resources that social workers deemed integral to their work with adolescents with disabilities. Finally, dialogue reflective of macrosystemic needs and challenges included environmental factors that adolescents with disabilities brought with them to school and that affected social workers\u27 intervention efforts. Consistent with social workers\u27 dialogue, recommendations for social work education, policy reform, and programs for adolescents with disabilities are presented

Reproductive and Sexual Healthcare Needs Among Adults with Disabilities as Perceived by Social Workers

People with disabilities often experience unique gynecological and reproductive healthcare needs, which may be exacerbated by their experience of sexual victimization. Previous research on adolescents with disabilities found that social workers held beneficial roles in supporting their clients to make empowered decisions concerning sexual healthcare, pregnancy, and parenting. This study aimed to assess the reproductive and sexual health needs of adults with various disabilities from the perspectives of their social workers. Eleven social workers working primarily with adults with various disabilities were interviewed using a phenomenological study design to offer their perspectives of the sexual and reproductive health needs of their clients. Interviews were transcribed and analyzed; themes and subthemes were identified. According to social workers, (1) adults with disabilities experienced distinctive reproductive healthcare interactions and challenges, including specific needs that were uniquely related to risks for sexual victimization and (2) social workers performed several roles in supporting sexual and reproductive healthcare of these clients, including education and brokering. Social workers demonstrated the need to support clients within a biopsychosocial framework since their biological, psychological, and social needs intersected to either restrain or empower their reproductive health. Social workers played key roles in supporting their clients in reproductive and sexual health decision-making, yet appeared to struggle to address ethical dilemmas, especially those related to ensuring their clients’ well-being and self-determination. Secondly, the results of this study made a connection between challenges in adults with disabilities’ receipt of health wellness exams and histories of sexual victimization

Social Workers’ Roles in Supporting the Sexual and Relational Health of Children with Disabilities

The purpose of this study was to understand social workers’ roles in meeting the sexual and relational health needs of children (aged 3–11) with disabilities. We conducted semi-structured interviews with 12 social workers from a range of practice settings. A phenomenological lens privileged the perspectives of social workers in their definitions of disability and sought to convey the meaning they assigned to their experiences of working with children in practice concerning matters related to sexual and relational health. Social workers enacted a broad definition of disability and often came to work with youth in contexts labeled as sexually problematic. In the provision of sexual health services, social workers embodied commonly adhered to roles including as practitioners, enablers, advocates, brokers, and managers. Services are needed that promote positive sexuality and relational health among children with disabilities. It is important that social workers be proactive advocates for the full inclusion of people with disabilities as equal sexual citizens

DISABILITY, INTIMACY, AND SEXUAL HEALTH: A SOCIAL WORK PERSPECTIVE

Sexuality is a key aspect of human development and identity, yet people with disabilities frequently encounter social and political barriers to achieving healthy, autonomous intimate relationships. Society tends to associate disability with asexuality and often labels sexual behaviors among people with disabilities as problematic or deviant. Faced with these assumptions and resultant policies, how can social workers meet the needs of this diverse population across the life course.In Disability, Intimacy, and Sexual Health: A Social Work Perspective, Linton, Adams Rueda, and Rankin Williams compile comprehensive research and candid interviews with social workers to explore the complicated intersection of disability and sexuality. The book begins by detailing historical violations of the sexual and reproductive rights of people with disabilities, including forced castration and sterilization. It then explores current issues of sexuality and disability throughout the life course, starting with childhood and adolescence. The authors examine the increased risk of abuse and victimization that people with disabilities face while in romantic or sexual relationships and provide practice recommendations to help combat factors that contribute to this vulnerability. Other milestones across the life course are also explored, such as pregnancy and parenting, marriage and cohabitation, and intimacy in older adulthood. Throughout the book, the authors examine the micro, meso, and macro systems that affect the lives and relationships of people with disabilities.This book touches on psychiatric, intellectual, developmental, learning, neurological, and physical disabilities and gives voice to both practitioners and their clients. It is an unflinching look at the pressing challenges professionals can face while serving people with disabilities, essential for students, academics, policymakers, and practitioners in a variety of settings who wish to advocate for the full sexual citizenship of people with disabilities.https://digitalcommons.unomaha.edu/socialworkfacbooks/1005/thumbnail.jp

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications