Relationship, sex and health education: a role for EPs
Relationships, Sex, and Health education (RSHE) first came to my attention as an important topic for EPs 10 years ago, in my previous role as an Assistant Educational Psychologist (AEP).
I was working alongside a main grade EP to design and facilitate a puberty workshop for parents at a school for learners identified as having profound and multiple learning difficulties (PMLD). As this piece of work evolved, I became aware of the complexities and inequalities that learners identified with PMLD face in their RSHE education, which carries on into their adult lives (Blackburn & Komaromy, 2014).
This interest has persisted and continued to grow over the last few years through ongoing action research, thesis writing, article and blog publications, implementation of training for teachers, and partnership with the Sex Education Forum (SEF). I would like to share some of my thoughts, reflections, and ideas and I hope to continue to gather feedback in this important area.
Changes in the RSHE curriculum
RSHE is the learning we do related to the social, emotional, and physical aspects of growing up including human development, relationships, sex, wellbeing, sexuality, and sexual health (SEF, 2022). In the last few years, RSHE has undergone legislative changes (Children & Social Work Act, 2017) and school lessons became statutory in September 2020. The Sex Education Forum (SEF, 2022) argues there is overwhelming evidence for the protective function of RSHE and it has links to improving mental and physical health.
The implementation of RSHE is complex; laden with political, religious, and moral values (Halstead & Reiss, 2003). This entanglement with wider society has been exemplified time and time again (Moffat & Field, 2020), such as by section 28 of the Local Government Act 1988 which prevented schools from ‘promoting the acceptability of homosexual family relationships’ and later the challenges faced by the implementation of the inclusive ‘No Outsiders’ resource (NO; Moffat, 2015). Further to this, conservative MPs wrote to the prime minister in 2023, claiming children were “being indoctrinated with radical and unevidenced ideologies about sex and gender” (McSorley & Dunkley, 2024). These examples highlight the contradictions, mixed messages, and anxiety at play regarding RSHE which are demonstrated within our culture and media (Fairbairn et al., 1995).
RSHE for learners with Special Educational Needs
While RSHE for mainstream pupils is not always straightforward, this complexity is magnified for pupils with SEND. RSHE for those with SEND remains an under researched area and there is a ‘reluctance and confusion’ regarding the delivery of RSHE to pupils identified as having SEND (McDaniels & Fleming, 2016, p.216), relating to prevailing societal attitudes regarding people with learning disabilities (LD).
Those identified with LD may be viewed as ‘perpetually innocent’, so RSHE is seen as inappropriate or irrelevant (Murphy & Young, 2005). This is rooted in a eugenic past with a reductionist tendency to see those with disabilities as ‘eternal children’ or ‘at risk’ (Garbutt, 2008). Traditionally the sexuality of people with disabilities has been disregarded and stigmatised, entrenched in a dominant socio-cultural, heteronormative, and paternalistic view of the world (Esmail, 2010).
Löfgren-Mårtenson (2004) reasons that this position has stemmed from eugenic roots, which led to mass sterilization and segregation of people with disabilities. The subsequent legacy is that those with disabilities are often seen as sexually deviant (Di Giulio, 2003), irrelevant, asexual, prone to criminality, and as a problem to society (Richards et al., 2006). However, research has highlighted the vulnerability of people with SEND to abuse (Kitson, 2010). Others argue that the sexual vulnerability of those with SEND is socially constructed (Hollomotz, 2011) and it is the lack of education regarding self-advocacy which leaves learners with SEND vulnerable (Cambridge & Carnaby, 2000). The World Health Organisation (WHO) states the lack of RSHE for learners identified with SEND excludes them from society more than their disabilities (Nelson et al., 2020).
Research shows us that educators face various barriers; including an ambivalence to RSHE by teachers, flavoured by personal morals and beliefs, confounded by dealing with a lack of confidence and resources (Garbutt, 2008). A number of studies have examined the RSHE curricula for learners with SEND, criticising it for narrowly focusing on risk prevention and sexual offending over intimacy, pleasure, and desire (McCann et al., 2009, Sala et al., 2019), as well as using complicated, undifferentiated materials (Grieve et al., 2006). RSHE in special education is often reactive and vague, and so not meaningful to students (Gourgeon, 2009); this shows that materials for learners with SEND are historically underdeveloped and poorly understood.
Young people want more RSHE
A systematic review concerning the views of young people (YP) with Intellectual difficulties (ID) revealed a desire and interest from to learn about RSHE; with some wanting relationships and some wishing to be sexually active (McCann et al., 2019). Young people explain that RSHE is flavoured by the prejudice and paternalistic attitudes of adults (McCann, 2019), which draw from a limited, heteronormative script, reflecting restrictive cultural norms and biases (Löfgren-Mårtenson, 2012).
Further to this, young people report being policed by adults, with high levels of adult supervision, coloured by discourses of ableism, resulting in adults inhibiting young people’s ‘becoming an adult’ agenda (Frawley & Wilson, 2016). Young people often report that they are reluctant to criticise curriculums, as they remain dependent on those around them (Löfgren-Mårtenson, 2012). This reflects the diminished power of this group, who rarely complain of human rights violations, as they remain, for the most part, uninformed and therefore disempowered (Kramers-Olen, 2016).
Parents and carers face barriers implementing RSHE at home
Parents and carers are young people’s first educators and key partners for implementing RSHE, acting as potential facilitators or barriers (Reynolds, 2019). Arguably RSHE starts early within families, in early relationships, enacted through intimate care (Stein et al., 2017). Reynolds condenses findings from multiple studies to identify barriers for parents including
- anxiety
- prioritising other needs
- grief
- belief of disinterest
- view of YP as eternal child
- questioning ability for consent
- discomfort
- waiting for the child to ask
Chappell (2016) used Foucauldian discourse analysis to understand these barriers through a lens of power, highlighting a dual discourse of public/political versus private/personal. Additionally, Reynold indicates further possible RSHE difficulties for parents of children with SEND including prolonged need for intimate care support (less opportunity for privacy), fewer boundaries (including nudity), less resilience in families, and fewer opportunities for YP to be assertive. However, there is a lot of variety (Stein et al., 2019) and little research exploring families who feel confident with RSHE.
Brown at al. (2020) used a systematic review to understand the important variables in the design, content, and delivery of RSHE, calling for parents, pupils, and professionals to be fully involved at each stage and approaches to be evidence-based and person-centred. All reviews recommend a need to develop co-produced, person-centred programmes with attitudes and values as central. To address this recommendation, I began to investigate through my own research how this could be enacted in the real world.
RSHE and a role for EPs
EPs are well placed to support schools to grapple with this topic, through several facets of their work including individual, organisational, and systemic work: promoting inclusion at all levels (Cameron, 2016).
Universal work, such as the development of policy and organisational change informed by young people’s voices (Harding, 2017), is one such way. My research looked at the use of PATH to plan for an RSHE support group in a special school (Carpenter et al., 2023). This harnessed several aspects of the scope of EP work including facilitating group work (Hanko, 2016) and supporting collaborative organisational planning and change informed by stakeholders’ views.
I made use of participatory action research using an ethnographic approach to develop a group of key stakeholders and work over time to grapple with key issues, challenge different views and values in a safe containing space, and to develop mechanisms to promote the participation of pupils and parents in RSHE implementation and understand organisational change. Key findings illuminated the value of a facilitated, safe space to discuss challenging topics, highlighted ways to promote participation, and supported a broader view of the EP role.
The next steps we can take
Since completing this research, I have reflected on how RSHE is a subject area which touches much of the day-to-day work that EPs undertake and reflects their knowledge of child development including relationships and identity. By harnessing everyday activities such as consultation, assessment, and intervention (including statutory work), EPs are well-positioned to empower change by using reflection to discuss, review and refine evolving practice which includes the voices of relevant stakeholders (Fox, 2011).
I have used this lens to shape my work around RSHE and bring it into my everyday EP practice. This has included:
- posing questions during consultation related to RSHE and linked to the areas of SEND
- considering policy and practice with schools and relating RSHE policy to wider policies such as safeguarding and behaviour policies
- suggesting outcomes in advice which support the development of this strand of learning
- creating bespoke training for teachers in specialist provision.
This reflects suggestions made by a guide published by the Sex Education Forum (2020) for pupils identified with SEND, which explores the need to consider RSHE within provision for EHC plans and for RSHE to be discussed at annual reviews.
More broadly I have spoken about this subject to other EPs both within my service at development days and nationwide by speaking at the 2024 AEP conference and delivering a webinar for the AEP in March 2025. In addition, I have been accepted as a partner with the SEF, which gives me the opportunity to liaise with other educators and professionals. My aspiration is to continue the discussion within the EP profession and work together collaboratively with allied professionals through the challenges and opportunities.
I believe that RSHE related outcomes and provision comfortably sit within the areas of need set out by the SEND Code of Practice (2015) and within the scope of the Preparing for Adulthood framework. Therefore, my call for action is for EPs to encompass and embrace this in our existing work, including statutory advice, consultation, school development, group work, intervention, research and coproduction/collaboration with stakeholders. EPs can start by considering their own views, values, and experiences and opening discussions with colleagues. I hope to hear from you with more ideas and questions, so we can continue this important piece of inclusion work together.
References
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Brown, M., McCann, E., Truesdale, M., Linden, M. and Marsh, L., 2020. The design, content and delivery of relationship and sexuality education programmes for people with intellectual disabilities: A systematic review of the international evidence. International Journal of Environmental Research and Public Health, 17(20), p.7568.
Cambridge, P. & Carnaby, S. (2000). A personal touch? Managing the risks of abuse during intimate and personal care for people with learning disabilities. Journal of Adult Protection. 2(4), 4-16.
Carpenter, N., Lee, F. and Male, D., 2023. A role for educational psychologists: using Planning Alternative Tomorrows with Hope (PATH) and participatory action research (PAR) to develop a Relationships and Sex Education (RSE) support group with staff in a special school. Educational psychology in practice, 39(1), pp.92-110.
Chappell, P., 2016. Secret languages of sex: disabled youth’s experiences of sexual and HIV communication with their parents/caregivers in KwaZulu-Natal, South Africa. Sex Education, 16(4), pp.405-417.
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