My capstone project was integrating sexuality in OT curricula through developing an introductory sexuality and OT learning module for OTD students to increase comfort and confidence in addressing sexuality and intimacy in their future practice.

Motivation for this Capstone Project

As a future occupational therapist that identifies as a nonbinary, queer, polyamorous person living with invisible disabilities, I am extremely passionate about the area of sexuality and intimacy as it intersects with illness and disability. My OT mission is to practice through altruism to help marginalized populations reach occupational justice in all aspects of their lives, embracing the intersections of race, ethnicity, sex, gender identity, sexual orientation, and socioeconomic status. According to the American Occupational Therapy Association, as part of the Occupational Therapy Practice Framework, sex is considered an activity of daily living. I support occupational therapists embracing their unique role in addressing sexuality and intimacy and I believe that the freedom to express sexual orientation, gender identity, and creating intimate and loving connections are just as important to people’s overall health and well-being as any other meaningful occupation in their lives. This passion has led me through my path to OT, including my undergraduate studies in health sciences where I put in the extra effort to minor in gender, sexuality, and queer studies to broaden my knowledge on sexuality related issues, which I will apply to OT practice.

Whenever there is an opportunity to select a topic for research, this is the area I am drawn to and have been for over 10 years. During my undergraduate studies, I researched the intersections and barriers of sex and disability, including challenges older LGBT adults face in the healthcare system. A common theme in the literature is that healthcare professionals do not know how to navigate issues related to sexuality with their patients, resulting from how society desexualizes people with disabilities and the elderly and not being appropriately trained on how to navigate these topics within their practice. Further, during the literature review for this capstone project, the research indicated that occupational therapists, much like other health professionals, face barriers to addressing their clients’ sexuality and intimacy concerns for numerous reasons including lack of knowledge, skills, comfort, and confidence in addressing the issues. However, one of the primary barriers are due to provider attitudes, beliefs, and biases around sexuality and intimacy. Not only is this true for practicing occupational therapists, but for occupational therapy students as well, which is important to consider as the attitudes and beliefs which develop in school may carry over into practice. These biases, beliefs, and attitudes lead to limited views of sexuality, seeing it through a heteronormative lens as primarily a biological activity for reproduction purposes and is reserved for those young, able-bodied, and married. Assumptions about sexuality are often made based on age, gender, sexual orientation, physical abilities, mental and cognitive status, relationship status, and the stage of clients’ rehabilitation process. Further, there are presumptions that clients are not ready to discuss sexuality concerns, do not want sexuality addressed, or clients would feel embarrassed or offended by discussions about sexuality. As a result, these presumptions lead providers and soon to be providers to use their own discretion as to whom and when to bring up sexuality. This impacts students and providers sense of competence and skills in addressing sexuality and intimacy if it gets addressed at all. Additionally, those in marginalized identities are often left even further behind.

My OT mission is to practice through altruism to help marginalized populations reach occupational justice in all aspects of their lives, embracing the intersections of race, ethnicity, sex, gender identity, sexual orientation, ability, and socioeconomic status. Through a lens of intersectionality, inclusivity, and occupational justice for all, I aspire to be an OT that is not only knowledgeable in handling simple to complex sexuality issues with my clients but specialize in it in the long term. I endeavor to be an OT that clients can feel confident in getting their sex, gender, sexuality, and intimacy concerns addressed and be a resource for OT colleagues who want to expand on their knowledge in this area. Additionally, I aspire to educate next generations of OTs on feeling knowledgeable, comfortable, and confident in addressing issues of sex, gender, and sexuality in future practice with this capstone project as my launch pad!

Capstone Presentation – Integrating Sexuality Content into OT Curricula

Literature Review

Preparing-OTs-in-Sexuality-Literature-Review-Final-Draft

Manuscript – Integrating Sexuality Content into OT Curricula: Development of an Introductory Module

Hutchinson-J-Integrating-Sexuality-Content-into-OT-Curricula-Final-Draft-8_2021

The Module Process was Guided by the Taxonomy of Significant Learning and Integrated Course Design by L. Dee Fink

Example of Module Layout

Example of Presentation

Example of Learning Activities

As part of my capstone project, I created learning activities to engage students more in the content. With full credit and thanks for Beth Ann Walker, PhD, OTR for developing the Occupational Performance Inventory of Sexuality and Intimacy and the Occupational Therapy Sexual Assessment Framework, I adapted this incredible work to make this fun interactive activity to educate on the OTSAF constructs!

Intro-to-Sexuality-in-OT-Learning-Activities

Example of Additional Resource

This is included in the learning module as an additional resource for students who want to know how to apply the knowledge learned, this case study design incorporates addressing sexuality and intimacy concerns as part of routine OT practice.

Energy-Conservation-CRF-Case-Study-JH

Sexuality and OT References

  • Accreditation Council for Occupational Therapy Education. (2018). 2018 Accreditation Council for Occupational Therapy Education (ACOTE®) standards and interpretive guide (effective July 31, 2020). American Journal of Occupational Therapy, 72(Suppl. 2), 7212410005. https://doi.org/10.5014/ajot.2018.72S217
  • American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2). https://doi.org/10.5014/ajot.2020.74S2001
  • Annon, J. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioural treatment of sexual problems. Journal of Sex Education and Therapy, 2, 1-15 https://doi.org/10.1080/01614576.1976.11074483
  • Areskoug-Josefsson, K., & Fristedt, S. (2019). Occupational therapy students’ views on addressing sexual health. Scandinavian Journal of Occupational Therapy, 26(4), 306-314. https://doi.org/10.1080/11038128.2017.1418021
  • Eglseder, K., Webb, S., & Rennie, M. (2018). Sexual functioning in occupational therapy education: A survey of programs. The Open Journal of Occupational Therapy, 6(3), 13. https://doi.org/10.15453/2168-6408.1446
  • Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. https://doi.org/10.3109/09638280903419277
  • Fink, L. D. (2003). A self-directed guide to designing courses for significant learning. University of Oklahoma, 27(11), 1-33.
  • Fink, L. D. (2013). Creating significant learning experiences, revised and updated: An integrated approach to designing college courses. John Wiley & Sons.Hattjar, B. (Ed.). (2012). Sexuality and occupational therapy: Strategies for persons with disabilities. AOTA Press, American Occupational Therapy Association, Inc.
  • Higgins, A., Sharek, D., Nolan, M., Sheerin, B., Flanagan, P., Slaicuinaite, S., Mc Donnell, S., Walsh, H. (2012). Mixed methods evaluation of an interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability. Journal of Advanced Nursing, 68(11), 2559-2569. https://doi.org/10.1111/j.1365-2648.2012.05959.x
  • Hyland, A., & Mc Grath, M. (2013). Sexuality and occupational therapy in Ireland – a case of ambivalence? Disability & Rehabilitation, 35(1), 73-80. https://doi.org/10.3109/09638288.2012.688920
  • Lohman, H. L., Kobrin, A., & Wen-Pin, C. (2017). Exploring the activity of daily living of sexual activity: A survey in occupational therapy education. The Open Journal of Occupational Therapy, 5(2), 9. https://doi.org/10.15453/2168-6408.1289
  • MacRae, N. (2013). Sexuality and the role of occupational therapy [Fact sheet]. https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Sexuality.pdf
  • Mc Grath, M., & Sakellariou, D. (2016). Why has so little progress been made in the practice of occupational therapy in relation to sexuality? American Journal of Occupational Therapy, 70(1), 1-5. https://doi.org/10.5014/ajot.2016.017707
  • McGrath, M., & Lynch, E. (2014). Occupational therapists’ perspectives on addressing sexual concerns of older adults in the context of rehabilitation. Disability and Rehabilitation, 36(8), 651-657. https://doi.org/10.3109/09638288.2013.805823
  • Mellor, R. M., Greenfield, S. M., Dowswell, G., Sheppard, J. P., Quinn, T., & McManus, R. J. (2013). Health care professionals’ views on discussing sexual wellbeing with patients who have had a stroke: a qualitative study. PloS one, 8(10). https://doi.org/10.1371/journal.pone.0078802
  • Mohammed, A. (2017). Addressing sexuality in occupational therapy. OT Practice, 22(9), CE1-CE8.
  • Payne, M., Greer, D. L., & Corbin, D. E. (1988). Sexual functioning as a topic in occupational therapy training: A survey of programs. The American Journal of Occupational Therapy, 42(4), 227-230. https://doi.org/10.5014/ajot.42.4.227
  • Stead, A., & White, J. (2019). Loss of intimacy: A cost of caregiving in aphasia. Topics in Language Disorders, 39(1), 55-70. https://doi.org/10.1097/TLD.0000000000000175
  • Taylor, R. R., & Kielhofner, G. (2017). Kielhofner’s model of human occupation: Theory and application (5th ed.). Wolters Kluwer.
  • Tepper, M. S. (2000). Sexuality and disability: The missing discourse of pleasure. Sexuality and Disability, 18(4), 283-290. https://doi.org/10.1023/A:1005698311392
  • Walker, B.A. (2020). Occupational Performance Inventory of Sexuality and Intimacy [Measurement instrument]. https://uindy.edu/health-sciences/ot/opisi
  • Walker, B., Otte, K., LeMond, K., Hess, P., Kaizer, K., Faulkner, T., & Christy, D. (2020). Development of the Occupational Performance Inventory of Sexuality and Intimacy (OPISI): Phase one. The Open Journal of Occupational Therapy, 8(2), 1-18. https://doi.org/10.15453/2168-6408.1694
  • Whitney, R. V., & Fox, W. W. (2017). Using reflective learning opportunities to reveal and transform knowledge, attitudes, beliefs, and skills related to the occupation of sexual engagement impaired by disability. The Open Journal of Occupational Therapy, 5(2), 8. https://doi.org/10.15453/2168-6408.1246
  • Young, K., Dodington, A., Smith, C., & Heck, C. S. (2019). Addressing clients’ sexual health in occupational therapy practice. Canadian Journal of Occupational Therapy, 1-11. https://doi.org/10.1177/0008417419855237

Learning and Instructional Design References

  • Fink, L. D. (2003). A self-directed guide to designing courses for significant learning. University of Oklahoma, 27(11), 1-33.
  • Fink, L. D. (2013). Creating significant learning experiences, revised and updated: An integrated approach to designing college courses. John Wiley & Sons.
  • How to Run a Usability Test in 5 Steps. Hotjar. (2020, June 13). https://www.hotjar.com/usability-testing/process-examples/.
  • Moran, K. (2019, December 1). Usability Testing 101. Nielsen Norman Group. https://www.nngroup.com/articles/usability-testing-101/.
  • Romadka, J. (n.d.). A simple template for writing usability tasks. UserZoom. https://www.userzoom.com/usability-testing/a-simple-template-for-writing-usability-tasks/.
  • Rothwell, W. J., Benscoter, G. M., King, M., & King, S. B. (2016). Mastering the Instructional Design Process: A Systematic Approach (5th ed.). John Wiley & Sons.
  • Schade, A. (2013, October 12). Remote Usability Tests: Moderated and Unmoderated. Nielsen Norman Group. https://www.nngroup.com/articles/remote-usability-tests/.
  • Wiggins, G. P., & McTighe, J. (2008). Understanding by design. Association for Supervision and Curriculum Development.
  • What is UX Research? The Interaction Design Foundation. (n.d.). https://www.interaction-design.org/literature/topics/ux-research.