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For many, sexuality is an important part of the human experience. In fact the American Occupational Therapy Association (AOTA, 2014) identifies sexual activity as an activity of daily living (ADL) and defines sexual activity as "engaging in activities that result in sexual satisfaction and/or meet relational or reproductive needs" (p. S19). Additionally, the World Health Organization (WHO) supports the belief that all individuals have the right to sexual education, intimacy, and meaningful relationships. The WHO (2013) identifies sexual rights as the rights of all people to attain the highest level of sexual health, including access to sexual health services.
Despite the knowledge that sexual health and intimacy are important aspects to consider when working with individuals with disabilities, research has demonstrated that education is often inadequate to facilitate a successful return to this ADL (Fisher et al., 2002; Forsythe & Horsewell, 2006; Hess, Hough, & Tammaro, 2007). Sexuality is often inadequately addressed because of several factors that influence the health care provider. These barriers include staff comfort, attitudes, and knowledge (Booth, Kendall, Fronek, Miller, & Geraghty, 2003). Although formal sexuality education programs for health care providers have shown improvement in staff knowledge, comfort, and attitudes (Kendall, Booth, Fronek, Miller, & Geraghty, 2003), less intensive methods are available for improving these skills and enhancing the client experience relative to sexuality education (Hattjar, 2012; Hattjar, Parker, & Lappa, 2008).
PLISSIT
The PLISSIT model was developed by Jack Annon in 1976 as a method of addressing sexuality related concerns for sex therapy clients. It has been widely adopted by health care professionals as a means of approaching the topic of sexuality for the broader population. There are four stages associated with this model, with each stage requiring progressively greater knowledge and training.
P-Permission
This first stage focuses on granting clients permission to discuss their sexual concerns (Annon, 1976). After injury or disability, clients may have questions regarding how they can participate in sexual activities. They may not be sure how or with whom to broach the subject, resulting in a lack of information transmission. This is the most important step in the PLISSIT model, because without permission to discuss sexuality, clients may not have the opportunity to ask further questions reflected in the subsequent stages.
LI -Limited Information