Disability Culturally Competent Sexual Healthcare


Mona, L., Cameron, R.P., Clemency Cordes, C. (2017). Disability Culturally Competent Sexual Healthcare. American Psychologist, 72(9), 1000-1010.


In this article, based on Linda Mona’s invited presentation at APA 2017 upon receiving the 2017 Award for Distinguished Professional Contributions to Institutional Practice, the authors provide a thorough discussion of how improving disability cultural competence can provide a foundation for the necessary practice of exploring sexual health and wellness with people with disabilities (PWD). The authors introduce a disability and sexuality healthcare competency model (DASH-CM) to provide guidance for engaging in evidence-based, culturally competent assessment, and provide the foundation for treatment planning and intervention in the sexual health and wellness of PWD. In acknowledging the “clinical double taboo” represented by the intersection of discussions about sexual health and activity and the stigma commonly associated with disability, and providing foundational information about disability culture, identity, and unique challenges faced by this population, the authors lay the foundation for the need for improved education, training, and ongoing self-exploration for development of cultural competency in this domain. The authors outline the value of utilizing Disability-Affirmative Assessment and Treatment (DAT – a metatheoretical foundation for other therapeutic interventions) in improving the value of psychological services to PWD through improving psychologists’ awareness of disability experiences, ability to discuss disability cultural values and strengths, and to encourage and model empowerment through awareness of and access to disability-specific resources. The article goes on to further elaborate on the DASH-CM, including ways to improve psychologists’ self-awareness of implicit beliefs related to sexuality and disability, as well as to assess implicit beliefs harbored by patients. The authors provide practical recommendations for ways clinicians can improve this self-awareness in the context of disability and sexuality, and to improve knowledge of identity, contextual, and political factors related to the sexuality experience of PWD. Finally, they provide direct recommendations for skill development and explore practice and application of this competency model in training, assessment and treatment, accessibility, and the provision of psychoeducation relating to resources to enhance the sexual experience of PWD. Throughout the article, references are made to additional research and resources to further education and awareness on this topic.

I SELECTED THIS ARTICLE BECAUSE as an early career psychologist (who was unable to attend Dr. Mona’s lecture) currently practicing in a multidisciplinary setting, I can attest to the discomfort many professionals have in broaching the topic of sexual health and wellness with any patients, let alone with PWD. This article presents the importance of examining this topic with patients, and emphasizes the foundational role of understanding and having competency with the culture of disability when working with PWD. In this way, it introduces these concepts to a wider audience of psychologists who often work with PWD but may not have training in rehabilitation psychology, and sets the bar for clinically competent care for an under-served population, particularly in relation to an under-served topic – sexual wellness.  The article provides references to additional resources and research, and includes an outline of the proposed clinical competencies as well as a series of questions that can assist in exploration of personal biases. It is immediately useful to educators, students, and practitioners.

THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Casey Dawson, Ph.D., Rehabilitation Psychologist in the Rehabilitation Psychology Department of Memorial Rehabilitation Institute, Hollywood, FL and a Member of Division 22's Science Committee.