Making the Shift in Services

Making the shift to a sexual and reproductive health approach to services takes time, flexibility, communication with community members, commitment from policymakers, new methods of monitoring and evaluation, and the patience to make change slowly. This model involves a shift in focus to a more holistic view of clients as unique individuals who engage in sexual activity not only for reproduction, but for pleasure.

Importance of training

Training providers and other service staff in sexuality issues is a critical step. This training may take place over time, and should focus on improving knowledge about sexuality, transforming attitudes, reflecting on values, increasing staff comfort with sexuality, and developing communication and counseling skills. In addition to the basics of sexual anatomy and physiology, behaviors, response, and dysfunction, training should focus on the potential impact of contraceptives, infections, and medical procedures on sexuality.

Attitudes/values/comfort
An essential component of staff training is to help staff reflect on their own attitudes and values related to sexuality. Staff should explore their perceptions, feelings, and attitudes toward sex, gender, body image, youth, aging, sexual behaviors and practices, sexual orientation, and sexual identity—as well as reflect on their own biases and how those biases may interfere with providing services that meet the needs and improve the health of clients.

Exercises that explore client myths and misconceptions about sexuality and health can often help staff confront their own. Other exercises may build staff comfort by examining the terminology used to discuss sexual matters and identifying terminology that would be both acceptable to and understood by the client and comfortable for the provider. These exercises and others that may remove some of the mystery around sexual behaviors help staff to build a sufficient level of comfort with the issues so that they can talk about sexual matters in a professional and nonjudgmental manner.

Communication/counseling skills
Another key component is building communication and counseling skills around sexuality. Role play or observation and analysis of real counseling can help staff practice building rapport with clients and feel comfortable discussing difficult topics.

In this type of training, staff can develop skills for broaching subjects in a sensitive manner and probing for important information. Providers can also learn some of the drawbacks of failing to elicit sufficient information during counseling through role plays that reveal an underlying problem that is not readily presented by the client. Exercises can also focus on helping clients change behavior and develop skills for negotiating the terms and conditions of sexual encounters, including safer sex.

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