Gallagher, Andrea (2011) Investigating staff's attitudes and

133 Pages·2012·0.79 MB·English

by  Andrea Gallagher

Gallagher, Andrea (2011) Investigating staff’s attitudes and willingness
to support men and women with mild intellectual disabilities on matters
relating to their sexuality. D Clin Psy thesis.

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Investigating staff’s attitudes and willingness to support men and women with
mild intellectual disabilities on matters relating to their sexuality
&
Clinical Research Portfolio

Volume I
(Volume II bound separately)

Andrea Gallagher
July 2011

Submitted in part fulfilment of the requirements for the Degree of
Doctorate in Clinical Psychology (D. Clin. Psy.)
Faculty of Medicine Graduate School

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Please complete the information below in BLOCK CAPITALS.

Name ANDREA GALLAGHER

Matriculation Number 0807828

Course Name DOCTORATE IN CLINICAL PSYCHOLOGY

Assignment Number/Name CLINICAL RESEARCH PORTFOLIO

DECLARATION:

I am aware of the University’s policy on plagiarism and certify that this assignment is my own work.

Signed……………………………………………………………..…….. Date……………………….

1
Acknowledgements
First and foremost I would like to thank my research supervisors Professor Andrew Jahoda
and Dr Jaycee Pownall. Their patience, support, and guidance has been invaluable in
devising, implementing and writing this research.

I would like to thank all of the support staff who took time to complete questionnaires and
share their experiences of supporting the service users they work with. Without your help
this research would not have been possible.

I would like to acknowledge my clinical supervisors for the knowledge and assistance they
have given me during my training.

I would like to say a big thank you to my study group and fellow trainees who offered
friendship and invaluable support when needed, making my training experience both
memorable and enjoyable.

I am grateful for the endless encouragement my family and friends have given me, both in
applying for, and working through, this training course. To Kathleen and Geraldine, you
both were always there to offer me support when needed and I’m looking forward to
spending more time with you, and of course little Lucy! A huge thank you goes to my
wonderful partner David. Your unfaltering encouragement helped me to keep going. You
have always been there for me, whether it’s making me smile through the stress, taking care
of things round the house and reminding me that I can do this! Last, but definitely not least,
my mum and dad. You have always believed that I can do anything I set my heart on, and it’s
your faith in me that has helped me achieve all that I have. I don’t think I would have got this
far without your help and support. Thank you for always being there.

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Table of Contents
Page
Declaration of Originality Form 1
Thesis Access Declaration Form 2 – 3
Acknowledgements 4

Volume I
Chapter 1
Systematic Literature Review 7 – 47
A distinct relationship: do support staff who work with people with intellectual
disabilities hold liberal attitudes towards their sexuality?

Chapter 2
Major Research Project 48 - 85
Investigating staff’s attitudes and willingness to support men and women with
intellectual disabilities on matters relating to their sexuality.

Chapter 3
Advanced Clinical Practice I: Reflective Account (Abstract only) 86 - 87
Facilitating reflective practice within a multidisciplinary team trained in
psychosocial interventions: roles, responsibilities and resistance.

Chapter 4
Advanced Clinical Practice II: Reflective Account (Abstract only) 88 - 89
Developing the role of the clinical psychologist: managing barriers to self
progress when working in teams.

5
Appendices Page
Appendix A Requirements for submission to Journal of Intellectual 90
Disability Research
Appendix B Participant Background Information Sheet 91 - 92
Appendix C Semi-Structured Interview 93 - 95
Appendix D Attitudes to Sexuality Questionnaire (Men with 96 - 99
Intellectual Disabilities) & Attitudes to Sexuality
Questionnaire (Women with Intellectual Disabilities)
Appendix E Ethical Approval Letter 100
Appendix F Participant Consent Form 101
Appendix G Participant Covering Letter 102
Appendix H Participant Information Sheet 103 - 105
Appendix I Flow Chart of Recruitment 106
Appendix J Example Quotes from Semi-Structured Interviews 107 - 111
Appendix K Major Research Project Proposal and Addendum 112 - 133

Volume II (Bound Separately)
Chapter 3
Advanced Clinical Practice I: Reflective Account 2 - 18
Facilitating reflective practice within a multidisciplinary team trained in
psychosocial interventions: roles, responsibilities and resistance.

Chapter 4
Advanced Clinical Practice II: Reflective Account 19 - 34
Developing the role of the clinical psychologist: managing barriers to self
progress when working in teams.

6
Chapter 1: Systematic Literature Review
A distinct relationship: do support staff who work with people with intellectual disabilities
hold liberal attitudes towards their sexuality?

Author: Andrea Gallagher*1
Mental Health and Wellbeing, University of Glasgow*

Address for Correspondence1
University of Glasgow
Mental Health and Wellbeing
Gartnavel Royal Hospital
1055 Great Western Road
Glasgow
G12 0XH
Tel: [phone]
Fax: [phone]
Email: [email protected]

KEYWORDS: intellectual disability, attitudes, staff, sexuality

Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical
Psychology (D. Clin. Psy.)
Prepared in accordance with requirements for submission to: Journal of Intellectual
Disability Research (Appendix A)
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Abstract
Background
Historically attitudes to sexuality for people with intellectual disabilities (ID) have been
reported as conservative and restrictive. In recent years advances have been made in the
rights and quality of life for people with ID. Support staff have an important role in assisting
the lifestyles of the service users they work with, hence understanding their attitudes to
sexual matters is important. This systematic review explores the recent research investigating
support staff’s attitudes on this topic.
Method
A search of relevant electronic databases, key journals and reference list was carried out to
indentify papers. Eight studies were included in this review and a quality rating tool was
used to explore findings.
Results
Support staff were found to hold relatively liberal attitudes. Nevertheless, some studies
found that attitudes to particular aspects of sexuality, such as parenting, were less liberal.
Findings were discussed in relation to the attitudes of relevant comparison groups such as
parents of people with ID.
Conclusions
Further research is required to explore whether staff’s attitudes impact on the support they
offer service users on sexual matters.

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Introduction
Forming personal relationships is an important aspect of a person’s life and developing a
positive sexual identity has been linked to individuals’ emotional wellbeing (Ailey et al.,
2003). Nonetheless, during the early twentieth century many individuals with intellectual
disabilities (ID) lived in institutions where they were often segregated and the opportunities
to develop sexual relationships were limited. Many people with an ID were sterilised against
their will (Craft & Craft, 1981). Generally, negative attitudes were held about the sexuality
of people with ID (Craft & Craft, 1981). Over time, opinions have become less restrictive,
however, carers often still hold cautious views about the sexuality of people with ID
(McCabe, 1999). Understanding staff’s attitudes to sexuality for people with ID is important,
as staff have a considerable influence on the interpersonal relationships of the individuals
they support.

Many people with ID are socially excluded and thus may rely on support staff for assistance
with various aspects of their lives. Forrester-Jones et al. (2006) reviewed the social networks
of 214 people with ID and found that individuals were most likely to seek emotional and
practical assistance from support staff. Agar et al. (2001) also found that staff members
and/or other peers were the most likely sources of support for adults with ID. In addition, it
was found that few contacts were made with other people from the general population, for
example neighbours. Pownall (2010) reported that young people with ID were less likely to
discuss sexual issues with their peers and were found to have inaccurate knowledge on sexual
matters. Moreover, an individual’s sexuality is a very private matter, and people with ID
have reported feeling wary about accessing information or support about sexual matters, in
part, due to fears that those they seek support from may react negatively (Morrison, 2007).
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As such, it is important that people with ID have supportive staff members who hold positive
views about their sexuality and are willing to assist with sexual matters. This would help to
ensure that service users’ sexuality is developed and expressed in a healthy, safe way.

A liberal attitude can be defined as a way of thinking which is tolerant and open minded
(Oxford English Dictionary, 2011). Measures which have been developed to explore staff’s
attitudes to sexuality, for instance the Attitudes to Sexuality Questionnaire – Individuals with
an Intellectual Disability (ASQ-ID; Cuskelly & Gilmore, 2007), have investigated whether
staff hold liberal attitudes, that is if staff have positive or accepting attitudes to the sexuality
of people with an ID. It could be considered that staff who hold liberal attitudes are more
likely to be accepting of people with an ID having opportunities to develop relationships,
express their sexuality and make informed choices about their sexual matters regardless of
whether they agree with the choices individuals with ID make. This could cover different
aspects of sexuality such as sexual health matters, parenting and intimate relationships. As
staff play a significant role in the lives of people with ID, their beliefs may impact not only
on the support that service users receive for sexual matters but also their opportunities to
develop positive and fulfilling relationships.

This link between a person’s attitudes and their behaviour has been explored within the
Theory of Reasoned Action (TRA; Fishbein & Ajzen, 1975) and developed further within the
Theory of Planned Behaviour (TPB; Ajzen, 1991). Both theories propose that subjective
norms and a person’s attitudes determine their behavioural intentions, predicting behaviour
itself. The formation of attitudes is influenced by a person’s beliefs about the outcome of
behaviour and their evaluation of this outcome. Such salient beliefs can be influenced by
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