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Touch
'Touch is the means by which children at an early development stage learn much about the world and their communication with others and, for those with visual impairments, their hands are their 'eyes'. (Health Education in Scottish Schools: Meeting Special Educational Needs, 1994)
Teaching about appropriate touch should start from an early age, emphasised and modelled in positive interactions between adults and between adults and children.
Safeguards for children
Whilst training about giving and receiving inappropriate touches is necessary in order to protect children from physical and sexual abuse or stigmatisation and ridicule, it should involve careful consideration of the child's individual social and emotional needs, level of cognitive ability and understanding and the attitudes of staff, parents and the wider public.
It is important that touch is not withdrawn from older children with the most profound disabilities for whom it will always be essential for providing reassurance and further personal and social development. Opportunities for physical contact which satisfy emotional needs can be provided in various ways eg in movement and sensory activities and, with visually impaired pupils, through hand-over signing and sighted guiding. 'Yes' and 'no' touches can be explored in non-threatening situations and by use of 'permission' games (accepting or rejecting an object) or demonstrated using models, puppets or pictures.
Massage
Massage is now commonly used with children who have complex learning disabilities in order to develop sensory and body awareness, tolerance to touch and as a means of relaxation. It is not uncommon for teachers and auxiliary staff to be involved in delivering aspects of programmes devised by physiotherapists and occupational therapists to assist individual children.
When using massage, staff need to recognise the child's vulnerability. Approaching a child through touch in this way should be done within a relationship of trust, built up gradually with staff who know the child well and who can sensitively interpret and respond to the child's reactions.
It is recommended that massage be confined to parts of the body such as the hands, feet and face in order to safeguard the interests of both staff and children.
'The Massage and Aromatherapy Guidelines: Working with Children and Adults with Learning Difficulties', (Mcconnell A, 1994) gives information and guidance about appropriate methods which can be used.
Intensive Interaction:
Safeguards for staff
Staff in one school consulted said of intensive interaction, 'An older boy likes to try to interact with staff in a personal way. The whole staff team has become concerned about this. How do you say 'no' when you are trying to build up a relationship? Staff could be vulnerable as the casual observer might take the wrong message. Children learn to know which members of staff allow certain things'.
During intensive interaction, physical contact occurs naturally between staff and child. Interactive activities should be carried out by adults whom the child knows well and trusts. However, staff must operate within understood limits. Where those limits lie will vary according to the age, gender and needs of the child.
If a child touched a member of staff in a way that makes him/her feel uncomfortable, for example touching a woman's breast, this can be gently but firmly discouraged in a way which communicates that the touch, rather than the child, is unacceptable.
Alternative and augmentative communication
Alternative or augmentative communication systems are often used with children and young people who experience difficulties with language and communication.
These systems are defined as follows in, The Education of Pupils with Language and Communication Disorders (SOEID, 1994):
'Alternative Communication System: a communicative system which is used in place of spoken language, for example by deaf children with severe dysarthria. Alternative communications include sign languages, formal and informal sign systems, pictorial systems and written language.
Augmentative communication system: a communication system other than a spoken language which is used to supplement or support spoken communication. The same systems (such as sign languages, formal and informal sign systems, pictorial systems and written language) may be used either as augmentative communication systems (to supplement spoken communication) or as alternative communication systems to replace spoken communication.
Augmentative communication systems can be divided into two categories:
Unaided - for example, the use of gesture/facial expression/body posture and position/eye contact and eye pointing/sign language.
Aided - for example, the use of written language/a letter board/pictures or photographs/symbol systems/communication aids (such as the Touch Talkers and Intro Talkers)/computer based systems.'
Further details about alternative and augmentative communication systems can be obtained from:
Keycom (Lothian Communication Service)
29 Bryson Road
Edinburgh
Tel: 0131 313 1656
Signs, symbols and gestures to do with personal and social development, including intimate aspects of care, are included in several of the alternative and augmentative communication systems commonly used in schools (see Bibliography). Members of staff providing intimate care should become familiar with and use appropriate signs with individual children, always accompanied by the spoken word.
These children and young people will be particularly reliant on staff to interpret and respond to their body language and, where this is possible, more formal means of communication.
Personal passports
Children with communication difficulties are vulnerable, particularly at times of transition, for example, when meeting new people or moving to new situations. In these circumstances their independent communication skills may not be adequate to convey relevant information regarding their particular needs.
The personal passport is a highly personalised and practical booklet or document written in a simple and direct way, which reflects the individual's personal style as well as supplying information which can inform others about ways of ensuring comfortable and safe experiences for the child.
The passport aims to create a highly positive view of the child and to stimulate more productive involvement of key people by encouraging awareness and confidence, shared knowledge and increased consistency of care. Specific information and instructions on intimate care should be recorded where necessary. Consideration should be given to the best method of ensuring that sensitive information is kept confidential, for example, using a loose-leaf format from which sensitive information can be extracted when necessary. (See Appendix 8.)
Further details about Personal passports can be obtained from:
CALL Centre
University of Edinburgh
4 Buccleuch Place
EDINBURGH
EH8 9LW
Tel: 0131 667 1438
An information pack is available.
Socio-sexual aspects of intimate care
In the context of equal opportunities and equal access to the curriculum, all young people, including those with special educational needs, have a right to know and understand as much as they can about themselves, their bodies and their sexual identity. A programme of education about sexuality, structured to suit the needs of individual children, provides a vehicle for personal development, exploring relationships, and appropriate decision-making about sexual matters. By providing appropriate language and knowledge about sexual matters, it also gives young people the opportunity to communicate worries and concerns and to learn skills to keep themselves safe.
The content of any programme on sexual development in a school or residential establishment should be set in the context of personal and social development. Above all, it is about relationships with other people.
Pupils with special educational needs are less likely than their peers to learn incidentally about sexual development. They may also have difficulties in understanding society's conventions and expectations regarding sexual behaviour. For example teaching children and young people who masturbate in public that this is a private activity can be a difficult and sensitive issue for both staff and parents, especially with older adolescents and those with profound disabilities. Some guidance on useful approaches is given but there should always be close consultation with parents on this matter and it may be necessary to seek specialist advice through, for example, the school medical service.
It is important that all staff working with young people and their parents are aware of and agree about the methods, approaches and the content of any teaching to do with sexuality.
For young people with profound and multiple disabilities, specific teaching about sexual development and behaviour will often be most appropriately undertaken with a member of staff with whom they have a good relationship and in a way that is tailored to their individual needs.
The bibliography contains references to recently published guidelines, teaching and staff development materials which may be helpful to schools in planning their own programmes.
Issues related to sexuality
Changing
Staff need to be aware that boys may have penile erections during washing and changing and they should accept this as natural and normal.
Menstruation
Menstruation is a normal physical function but girls and young women who have special educational needs may need extra reassurance when they reach puberty. They may also need straightforward guidance, instruction and assistance to cope with the practical aspects of menstruation.
Such assistance should be provided by a female member of staff as she is also more likely to recognise associated mood swings or discomfort.
Masturbation
Interest in one's own body and other people's bodies is part of normal development. Children and young people with disabilities develop the same feelings and needs as others though expressing them may be more difficult.
Masturbation is normal sexual behaviour but it may take place in an inappropriate context. When this happens, staff and parents should consult about what approach to take. The approach adopted will vary according to the child's age and stage of development and level of understanding. Boredom or stress may be important factors which an be alleviated by diverting attention to more rewarding and interesting activities. Any possible medical causes should also be investigated.
There are teaching programmes such as Living Your Life (ED Craft. A, LDA, 1991) which provide sensitive line drawings about masturbation and appropriate behaviour.
Wherever possible, young people need to experience 'personal space' where their privacy is respected. Incidental learning is often not enough. They may need for example to be given some time alone in a room with the door closed and where others knock on the door before entering.
If masturbation occurs inappropriately, young people can be directed to a place which they have experienced as being 'private'. If this in turn leads to frequent interruptions to the normal day, other strategies will need to be explored about setting clear boundaries regarding when and where and how often masturbation is acceptable
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