Sexuality in children and adolescents with disabilities.
Murphy N. Department of Pediatrics, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA. nancy.murphy@hsc.utah.edu Dev Med Child Neurol. 2005 Sep;47(9):640-4. Comment in: Dev Med Child Neurol. 2008 Aug;50(8):563.
This review presents a discussion of the sexual development of children and adolescents with disabilities, described in the framework of body structure and function, individual activities, and societal perspectives presented in the World Health Organization’s International Classification of Functioning, Disability and Health. Issues of sexual development, gynecological care and contraception, sexual functioning, societal barriers, sexual victimization, and sexuality education are presented. Overall, adolescents with disabilities seem to be participating in sexual relationships without adequate knowledge and skills to keep them healthy, safe, and satisfied. Although their sexual development may be hindered both by functional limitations and by intentional or unintentional societal barriers, the formal and informal opportunities for teenagers with disabilities to develop into sexually expressive and fulfilled persons do exist. Health care providers are urged to increase their awareness of this unmet need and to implement strategies that promote the physical, emotional, social, and psychosexual independence of children, teenagers, and young adults with disabilities.
Dental education and special-needs patients: challenges and opportunities.
McTigue DJ. Department of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio, USA. mctigue.1@osu.edu Pediatr Dent. 2007 Mar-Apr;29(2):129-33.
Pediatric dentists have, by tradition and default, provided care for persons with special health care needs (PSHCN), regardless of age. Deinstitutionalization of PSHCN in the 1960s, however, overwhelmed the dental care system, and oral health care became one of the greatest unmet needs of this population. This presentation follows the history of training for dentists in this aspect of care, from the first demonstration programs in the 1970s to the current educational programs in U.S. dental schools. Today’s dental students must be competent in assessing the treatment needs of PSHCN, but accreditation standards do not require competency in the treatment of this group of patients. Recommendations to rectify this include revising dental school curricula to be more patient-centered, improving technology in schools, earlier clinical experiences for dental students, and the use of community-based clinics.
Interprofessional educational partnerships in school health for children with special oral health needs.
Mabry CC, Mosca NG. Louisiana State University Health Sciences Center School of Dentistry, Advanced Education and Hospitals, 8000 G.S.R.I. Avenue, Building 3110, Baton Rouge, LA 70802, USA. cconni@lsuhsc.edu J Dent Educ. 2006 Aug;70(8):844-50.
Dental caries is an infectious yet preventable disease that is rampant in some subpopulations in the United States, in particular among individuals with neurodevelopmental/intellectual disabilities (ND/ID). This article reports on the implementation and evaluation of the Louisiana State University Health Sciences Center (LSUHSC) School of Dentistry interprofessional school health educational model to improve oral health assessment and referral for children with ND/ID in an inner-city school system. During this project, dental hygiene students and elementary school nurses were paired to assess the oral health status of 255 inner-city children with developmental disabilities, improve referral/access to dental care for those identified as having need, and propose dental hygiene curriculum changes that would incorporate participation in a “real-life public health setting” for those with ND/ID. Following the program, 66 percent of dental hygiene students said their likelihood of participating in future oral health programs had increased and 75 percent of school nurses rated the educational process as very good or excellent. Modifications in dental hygiene curricula that provide students with training and experience in oral health risk assessment and referral for people with ND/ID is recommended to address the new Commission on Dental Accreditation educational standards 2-18 and 2-26 (implemented January 1, 2005) and dental standard 2-26 (implemented January 1, 2006), which state that dental hygiene and dental graduates must be competent in assessing the treatment needs of patients with special needs.
Sexuality of children and adolescents with developmental disabilities.
Murphy NA, Elias ER. Pediatrics. 2006 Jul;118(1):398-403.
Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.
Mandating education of dental graduates to provide care to individuals with intellectual and developmental disabilities.
Waldman HB, Perlman SP. Department of General Dentistry, SUNY at Stony Brook, Stony Brook, NY 11794-8706, USA. hwaldman@notes.cc.sunysb.edu Ment Retard. 2006 Jun;44(3):184-8.
In 2004, The Commission on Dental Accreditation adopted new standards for dental and dental hygiene education programs to ensure the preparation of practitioners to provide oral health services for persons with special health care needs. The course of action leading to the adoption of the new standards, together with the continuing obstacles of limited government support for dental services and the availability of faculty members to provide the needed dental educational experiences is reviewed. Expanding Health Resources and Services Administration definition of medically underserved areas is presented as one approach to improving the delivery of dental services.
General dentists and special needs patients: does dental education matter?
Dao LP, Zwetchkenbaum S, Inglehart MR. School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA. J Dent Educ. 2005 Oct;69(10):1107-15.
Special needs patients are one of the underserved dental patient groups in the United States. This study investigates whether undergraduate dental education about special needs patients affects general dentists’ a) professional behavior, b) practice characteristics, and c) attitudes concerning special needs patients. Data were collected from 208 general dentists (178 male/30 female; average age: 49.85 years) who were members of the Michigan Dental Association. The more the respondents agreed that dental education had prepared them well, the more likely they were to treat various types of special needs patients and to set up their practices so they could treat them and the more they liked treating these patients. In conclusion, most general dentists did not think their undergraduate dental education had prepared them well to treat special needs patients. However, the better they reported to have been educated, the more likely they were to treat special needs patients. Given the access to care problems for many special needs patients, it seems crucial to revise dental curricula and provide more didactic and clinical education concerning the treatment of special needs patients.
Education of dentists in the treatment of patients with special needs.
Thierer T, Meyerowitz C. Eastman Department of Dentistry, University of Rochester, School of Medicine and Dentistry, New York 14642, USA. J Calif Dent Assoc. 2005 Sep;33(9):723-9.
The dental education system has been suggested as the vital link in providing a workforce capable of improving oral health for people with special needs. Dental education institutions not only train dental professionals for their role in providing oral health services for people with special needs, they also provide a significant amount of services to this population in their clinical environments. However, there is no consensus about whether to concentrate the educational efforts on the preor postdoctoral level, or both. Furthermore, it is not clear if educational initiatives in the care of patients with special needs will translate into a larger oral health workforce willing to treat these patients. However, for the purposes of this paper, it will be assumed that more education and training in special care dentistry will lead to better-educated dentists and the desired result of better access to care for special needs patients. The authors will define special needs patients as those who have a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that the general population requires. This paper will describe accreditation issues and discuss the advantages and disadvantages of special care education in pre- and postdoctoral training and beyond.
Preparing dental graduates to provide care to individuals with special needs.
Waldman HB, Fenton SJ, Perlman SP, Cinotti DA. Department of General Dentistry, State University of New York at Stony Brook, Stony Brook, NY 11794-8706, USA. hwaldman@notes.cc.sunysb.edu J Dent Educ. 2005 Feb;69(2):249-54.
In 2004, the Commission on Dental Accreditation (CODA) adopted a new standard that directs dental and dental hygiene programs to prepare dental professionals for the care of persons with special health care needs. This article reviews the demographics of individuals with special needs, documents that most dental schools provide their students with very limited educational opportunities related to the care of this population, describes the path that was followed to bring about change in the accrediting standard, and discusses the difficulties involved in developing the needed educational programs. Educational programs at two dental schools are presented as examples of how schools can provide students with learning experiences pertinent to the new CODA standard that states: “Graduates must be competent in assessing the treatment needs of patients with special needs.”