再論智能障礙者性議題介入模式：從PLISSIT到Ex-PLISSIT   免費試閱

Re-Discourse the Rehabilitation Model on Sexual Issues of Individuals with Intellectual Disabilities: From PLISSIT to Ex-PLISSIT

自1976年性治療師Annon提出PLISSIT模式以來，此一循序漸進的四層次介入模式發展蓬勃，並應用在各個族群（含身心障礙者）的性健康促進上，影響性學與實務的發展甚鉅。近年來，身心障礙者的支持理念，自醫療模式、社會模式，進展至賦權及自我決策模式，其鑑定與福利服務需求評估系統亦調整為國際健康功能與身心障礙分類系統架構，此反映在性健康議題上，恰可因應身心障礙者獨特的性議題需求而提供適性支持。因為如此，PLISSIT模式也衍生出一些問題，諸如：未全然以服務對象的觀點、未考量其獨特的性相關行為需求、專業人員與服務對象二者之間的角色不平等及線性服務取向等侷限，而亟待改善。Davis與Taylor於2006年進一步提出Ex-PLISSIT模式，強調在任一層次的性健康支持服務，均需著重同理與尊重，並佐以反思與回顧之循環迴路的思維與作法。本修正模式視性為動態的概念，當生理、心理或社會情境改變，其意涵亦隨之有所不同，因此無法一次敘說完畢，因而個體的觀點應被聽見，始能往返回顧同理與資訊，此對智能障礙者性議題的評估、處遇及相關需求的支持，尤為適切。

PLISSIT model, developed by Annon in 1976, includes four levels of sex intervention: Permission, Limited Information, Specific Suggestions, and Intensive Therapy. The model has been used across a wide range of different groups to rehabilitate clients’ sexual health. Recently, the idea of supporting people with disabilities changes from medical model, social model, to empowerment and self advocacy model. Therefore, ICF identifies the support needs of sexual wellbeing for people with disabilities. However, some flaws of this model emerge, such as: non client-centered service, insufficient permission, a one-way process of assuming the active role of practitioners and the passive recipient of clients, and a linear approach from lower-level intervention to more developed intervention. So this model needs to be improved. This Ex-PLISSIT model proposed by Davis and Taylor in 2006, besides the original four levels, further requires to review all interactions with the clients and to reflect the attitude and impact on rehabilitation. The extended model addresses that sexuality is a dynamic concept and changes in response to the change of physical, social and psychological circumstances. Therefore, the four levels of PLISSIT are interconnected and can occur in any order. The two Rs, review and reflect, are used to listen to the clients’ voice and feedback information as a learning cycle. This model, including assessment methods, rehabilitation strategies, and supporting sexual health needs, is good to apply to individuals with intellectual disabilities.