Supporting autistic people with relationships and sexuality: An awareness raising workshop for social care staff

Dr Claire Bates &

Rose Matthews

choicesupport.org.uk

Who developed this training? 

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Dr Claire Bates (she/her) Lead Researcher

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“I have worked in social care for 20 years. I run a network that supports sexuality and relationships in social care called Supported Loving.”

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Rose Matthews (they/them) Research Assistant

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“I am an Autistic Autism researcher with a background in social work training, social care, learning and development, and advocacy work.” 

An advisory group of autistic people, all of whom have drawn on social care support, also helped to develop this training. 

Acknowledgement & Disclaimer 

This research was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey, Sussex.

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The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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Aims and Objectives 

Aim: To equip staff in adult social care settings to be better able to meet the sexuality & relationship support needs of autistic people they work with.

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Objectives

• To explore how being autistic may affect relationships and sexuality
• To highlight the role of social care workers in supporting autistic people with relationships and sexuality
• To think about how personal attitudes and values may impact on support provided professionally
• To reflect on existing strengths and skills, and consider future learning and development needs
• To consider challenges associated with providing this kind of support for autistic people, and ways of responding to these
• To signpost to other sources of information and advice on providing sexuality and relationship support for autistic people

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Welcome! 

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Please share your name and your role   �

Autism related terminology

Group Agreement 

We want this to be a safe space to discuss sensitive topics:

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• Treat others' opinions with respect  
• Maintain confidentiality within the workshop and outside it 
• Use 'hand up' feature / put your hand up (try not to interrupt) 
• Make space for other people to contribute to discussions 
• Value other participants' contributions to discussions
• Arrive back on time after breaks
• Keep an open mind, be kind

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What is Sexuality?

The World Health Organisation:

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'...a central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. 

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Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. 

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Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors.' 

What is Sexuality?

Care Quality Commission: 

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'Sexuality encompasses a person’s gender identity, body image and sexual desires and experiences. This means people can have needs relating to their sexuality, regardless of their age, mental capacity or personal history. The definition of sexuality for the purposes of this guidance is deliberately broad. It is important to recognise that sexuality can mean different things to different groups of people.'

 Relationships and Sexuality in Social Care (2019) 

Are any myths or stereotypes about autistic people's experiences of sexuality and relationships busted in this video clip? 

Are any myths or stereotypes about autistic people's experiences of sexuality and relationships busted in this video clip?  

Supporting autistic people who identify as LGBTQ+  �

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People who identify as LGBTQ+ don’t always have good experiences within social care services. University of Bristol researchers found that:

• More than 90% said that their needs as a person who identified as LGBTQ+ with a disability were either not considered at all or were only given some consideration when their needs were assessed or reviewed

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• More than a third said that they had experienced discrimination or received poor treatment because of their sexual orientation or gender identity

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• More than half of those surveyed said that they never or only sometimes disclosed their sexual orientation or gender identity.

(Regard & Stonewall, 2017)

Regard and Stonewall (2017)

Supporting autistic people who 

identify as LGBTQ+ / gender diverse

Supporting autistic people who identify as LGBTQ+ / gender diverse

Most of the 'Autistic Loving' research study interviewees who identified as LGBTQ+ and/or gender diverse said that they:

• Struggled to find partners
• Lacked safe spaces to meet likeminded people
• Had gaps in their sexual health knowledge because sex education was often aimed at heterosexual relationships
• Wanted support to explore their feelings surrounding sexuality and/or gender, or to be signposted to psychological support 

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What can be done to support LGBTQ+ autistic people within your role, including actions that you have taken or are currently taking? 

Group discussion  

Some ideas… �

• Social care staff should always ask people how they identify and what pronouns they use - typically he/him, she/her or they/them.

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• If someone has not communicated their sexual orientation or gender identity, it should not be assumed, it’s ok to put ‘don’t know’ on any support documentation. 

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• If a person wishes to change their sexual orientation or gender identity, or leave this “fluid” or undefined, staff should accept and respect their choices.

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• People within the LGBTQ+ community are more likely to come out to staff if they feel comfortable and safe to do so. Staff should receive training and support to create a non-judgemental space. 

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• Staff should be aware of local or online organisations that support LGBTQ+ autistic people so they can signpost people there if necessary.

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• Staff should be aware of any local LGBTQ+ social groups for autistic people and if none exist consider asking autistic people if they would like one to be set up locally and if they would like to be involved in this.

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• Staff must understand issues LGBTQ+ autistic people can experience and provide inclusive, anti-discriminatory support, taking into account other individual characteristics (e.g., ethnicity, culture, age, disability). 

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• Staff should be aware that many autistic people have not had sexual education that met their needs, so may need space to discuss sex and sexuality, referral to organisations, or access to appropriate resources. 

Is this really part of my role?�YES!

• Care Quality Commission (CQC): If staff provide any form of personal care, they are classified as a ‘registered service’ and must meet the regulations set by the CQC. Even if organisations are not CQC registered, meeting these criteria demonstrates best practice: Relationships and Sexuality in Social Care

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• Core Capabilities Framework for Supporting Autistic People. Capability 10: Relationships, sexuality and sexual health Autism-Capabilities-Framework-Oct-2019.pdf (skillsforhealth.org.uk)

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• Skills for Care published guidance on ‘Supporting people who need care and support to have meaningful and safe relationships’ in 2020 to provide practical support and guidance for staff. Supporting personal Relationships

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How confident do you feel?�Questionnaire / Poll (handout 1)

This online poll / questionnaire highlights the skills, knowledge and behaviour that social care staff supporting autistic people should have according to Skills for Health’s Core Capabilities Framework, which includes:

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• Support to maintain their relationships with family members/ their social network
• Support to develop new friendships and relationships, if they wish to
• Providing person-centred, autism-specific, age-appropriate sex and relationship information
• Signposting autistic people to person-centred, autism-specific, age-appropriate sex and relationship education or support
• Support to recognise healthy and unhealthy relationships and online risks
• Support to say no to unwanted relationships, including when they may be at risk of ‘mate crime’ or ‘cuckooing’
• Understanding how public services can take actions towards perpetrators of abuse to prevent and intervene in criminal activity
• Supporting sexual expression, including LGBTQ+ issues, in person-centred (age-appropriate) ways
• Support to access services that meet their sexual health needs (including preventive healthcare / education

Breakout group activity

Sam: case study (handout 2)�

What actions might you take? What legal duties (if any) do you have in a situation like this? What resources / services might be helpful?

You have been supporting Sam (an autistic adult) weekly for the last six months with cleaning, shopping and social activities. Sam met someone online a few months ago, started dating and they moved in almost immediately. You never see Sam alone now as they never want to go out and their partner is always at home, as they gave up working shortly after moving in.

When you visited, rubbish was piling up inside the flat, there were unopened bills and piles of dirty washing. Food in the fridge had gone mouldy. There were empty lager cans and cigarette ends even though Sam doesn’t drink and it’s a no smoking tenancy. Sam said not to worry as their partner is taking care of everything but looked overtired and had lost weight. When you texted and called Sam to arrange your next visit you didn’t get a reply. 

Sam: a case study �(feedback and discussion)

“A neighbour contacted the police after hearing a disturbance in Sam’s flat. Sam’s partner had repeatedly become abusive when drunk and had been taking away their phone to stop them from contacting anyone. Sam hadn’t said anything because they didn’t want to get their partner into trouble and they feared being hurt, or their partner harming themself. Sam told the police they felt stupid for getting into this situation but once things started to go wrong, they didn’t know what to do.”

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How could a situation like this potentially be avoided? 

Exploitation and abuse   �Some ideas on prevention  

For the person

• Relationship & Sex Education ('red flags’ , healthy / unhealthy relationships)
• Awareness raising about 'cuckooing' / 'gaslighting' / mate crime, domestic abuse (including coercive and controlling behaviour)
• Clare’s Law (Domestic Violence Disclosure Scheme) 
• Peer support- can provide emotional and practical support
• Practical advice on what to do if feeling threatened
• Crisis plan / safeguarding measures       

For staff 

• Training on domestic abuse and sexual exploitation 
• A clear organisational policy 
• An awareness of local organisations who could support the person 
• An understanding of the potential warning signs of domestic abuse / sexual exploitation / 'cuckooing', mate crime 
• A knowledge of appropriate resources to share with the person 

Experiences of providing support Breakout Group Activity (handout 3)

Research suggests that autistic people may benefit from support with: 

• Communication (two-way process)
• Social norms, rules and boundaries 
• Exploitation, abuse and vulnerability
• Dating process (online or in person)
• Developing long term relationships 
• The impact of being autistic on relationships 
• Physical intimacy including sensory issues  
• Sexual orientation & gender identity 
• Knowledge about sex and relationships 

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From your own practice experience:  

What challenges do the autistic people you support have in these areas?

What challenges have you had working with autistic people in these areas? 

Can you share any good practice examples?

Relationship & sexuality support 

Mel: You work with Mel, a non-binary person in their late 50s who was previously in relationships with men. Mel now realises that they are sexually attracted to women and would like to start a new relationship. They have several specific anxieties: Where can they go to meet potential partners in person or online? Will they be able to recognise when someone is flirting with them? Will their autistic differences be a barrier to making a lasting relationship?

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• What practical or emotional support might Mel need?
• How would you approach this with them?  

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Autistic Loving 

Mini case study: Mel 

Relationship & sexuality support 

What practical or emotional support might Mel need?

• Has Mel had an opportunity to explore their feelings with a therapist/ counsellor? This could be of benefit as a space to explore sexuality and anxieties surrounding a new relationship
• Are there any LGBTQ+ social groups locally/ online to potentially meet partners or likeminded friends?
• Would Mel like to use online dating or find a local dating agency?
• Are there any resources (books/ websites etc.) that could help Mel understand more about non-autistic communication regarding flirting?

How would you approach this with them?  

• Ask Mel if they would like any emotional support surrounding this and whether they need assistance to find some- an autistic therapist could be of benefit 
• See if Mel would like to find a local LGBTQ+ and/or autistic groups locally/ online and if they would like you to come with them for moral support or provide practical help (e.g. planning travel) 
• Find resources which might be helpful and share them with Mel and offer to discuss with them if they want

Mini case study: Mel 

Relationship & sexuality support 

Dan:  You work with Dan, an autistic 33-year-old man who has been dating his 31-year-old partner Zoe for the last two years. Dan wants to have sex with Zoe, but he is not sure how their relationship will ever progress beyond kissing and cuddling. Neither of them has had sex before and Dan isn’t sure how to find out if Zoe wants this too, without putting pressure on her, or asking bluntly, which might upset her. He is also worried about his lack of sexual experience and knowledge, which affects his confidence.    

• What practical or emotional support might Dan need?
• How would you approach this with him?  

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Autistic Loving 

Mini case study: Dan 

Relationship & sexuality support 

What practical or emotional support might Dan need?

• What education has Dan received regarding sex? Would he benefit from educational materials to help him feel more confident about sex. This would need to be pleasure-focused sex-positive education.
• What is Dan’s understanding of consent? Does he have a good understanding of what consent would look like/ sound like for his partner?
• Would Dan and Zoe benefit from some sessions together with a sexual therapist?

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How would you approach this with him?  

• Ask Dan if he would like you to help him access resources which could help him to understand and feel confident about sex? Be available to answer any questions
• Find resources that explain about consent and ask if Dan would like to talk them through with you? Ask if he would like to work through how he might approach Zoe, how to bring up the topic and be sure if she is consenting to sex
• Ask Dan if he would like to speak to a sexual therapist and offer to help him contact one

Mini case study: Dan 

Relationship & sexuality support 

Sarah: You work with Sarah an autistic 22-year-old woman who hasn’t had a relationship before. Sarah’s older sisters are both living with partners, and she tells you how frustrated she is that she never seems to meet anyone who is “boyfriend material”. Sarah has met a couple of men at work where there seemed to be a mutual attraction, but things didn’t go like they do in the soaps or the movies. She didn’t know what to say or how to react, and they quickly lost interest.

• What practical or emotional support might Sarah need?
• How would you approach this with her?  

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Autistic Loving 

Mini case study: Sarah 

Relationship & sexuality support 

What practical or emotional support might Sarah need?

• Could her social circle be widened to potentially meet more people she may be attracted to? Are there new social groups, activities or events (online or in person) she might want to attend or consider online dating?
• What is Sarah’s understanding of relationships and their development? If her learning is from soaps and TV this may need unpacking as relationships on TV rarely reflect everyday life
• Has Sarah had education surrounding relationships and flirting? She may need some advice and support surrounding this, including sexual safety, online safety and spotting ‘red flags’ on dates.

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How would you approach this with her?  

• Would she like support to expand her social circle- e.g. support to find new places/support to attend/ travel to new places or set up a dating profile
• Use soaps/ tv to discuss how relationship development can differ from real life e.g. often happens much slower, less often and less drama
• Ask Sarah if she would like support to find resources on dating (online and in person) and flirting and to talk through them if she would like

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Mini case study: Sarah

Key messages from the Autistic Loving study 

Understanding autism

• Don’t use a ‘cookie cutter’ approach, everyone is different
• Having said that, autistic people often have quite a lot in common
• A good understanding of autism is essential to provide effective support
• Always consider things from the autistic person’s perspective 

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Voiced by Lily, an Autistic Loving advisory group member.  

Key messages from the �Autistic Loving study 

A person-centred approach

• Don’t assume relationship or sexuality support is wanted or needed    
• Don’t assume relationship or sexuality support is not wanted or needed 
• Offer information in different formats to reflect personal preferences
• Consider videos / cartoons / social media / TV / websites / leaflets / books
• People can often learn a lot from the experiences of their autistic peers
• Someone’s life story, current situation, and future hopes are all relevant
• The impact of any co-existing condition/s should always be considered

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Voiced by Lily, an Autistic Loving advisory group member.  

Key messages from the �Autistic Loving study 

Accessibility issues

• Support should be offered in different ways (groups and/or one-to-one)
• Groups must be well planned / structured / managed, to avoid overwhelm
• Sensitive personal issues may be better discussed in one-to-one sessions
• Information sent in advance can assist with preparation / reduce anxiety
• Additional time is likely to be needed for processing and communicating
• Pacing, timing, and breaks are important to avoid overload / overwhelm
• The accessibility of the physical / online environment is very important
• Always ask about individual accessibility issues – don’t make assumptions
• Use clear and straightforward communication (avoid "fluffy" language)

Voiced by Lily, an Autistic Loving 

advisory group member.  

Key messages from the Autistic Loving study 

What to consider when providing support    

• There are many ways of providing support (both directly and indirectly) 
• It is important to clarify what role/s (if any) the person wants you to play  
• Some people may prefer to be signposted to another provider / specialist  
• Be non-judgemental, open-minded and unembarrassed in discussing sex
• Autistic people often develop trauma as a result of bullying / abuse
• More social opportunities are needed to reduce isolation
• Some people may prefer socialising with other LBGTQ+ autistic people

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Voiced by Lily, an Autistic Loving 

advisory group member.  

Key messages from the Autistic Loving study 

Support that might be helpful

• Providing a safe space to talk through sensitive topics/ check things out 
• Being able to help clarify and explain areas that are unclear (e.g. social norms or non-autistic communication)
• Practical support e.g. transport / setting up dating profile / events 
• Sexual and relationship safety support and advice, either to prevent problems or to help if something goes wrong
• Signposting to resources or help to understand resources provided
• Help to access psychological support / counselling / couples counselling
• Assistance to increase social contact and reduce isolation

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Voiced by Lily, an Autistic Loving 

advisory group member.  

Key messages from the Autistic Loving study 

Support that might be helpful (continued) 

• Providing support when a relationship gets into difficulty or ends
• Establishing a safe space for someone to talk about sex and relationships with their peers
• Support to understand development and maintenance of relationships
• Support to interpret and 'decode' communication (e.g. flirting)    
• Assistance with how to communicate effectively with a partner / potential partner, especially if they are non-autistic

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Voiced by Lily, an Autistic Loving 

advisory group member.  

How will you put into practice

what you discovered today? 

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What do you want to find

out more about?