Lead authors, Dr Caroline Knight and Professor Nick Alderman, together with a team of clinical colleagues, developed the St Andrew’s Sexual Behaviour Assessment (SASBA) scale after extensive background research identified a lack of shared definition and understanding of what constitutes inappropriate sexual behaviour.
They found that suitable observational recording measures for inappropriate sexual behaviour in people with progressive and acquired neurological conditions were not available. This, together with sensitivities surrounding the discussion of sexual behaviour, led to difficulties in proper assessment.
Developing a scale like SASBA presented both ethical and practical challenges. A range of quantitative and qualitative research methodologies were used to evolve the SASBA scale. The study was carried out using two of St Andrew’s services, the National Brain Injury Centre, and our neurodegenerative services, which has many residents over the age of 60 with progressive neurological conditions, and a Huntingdon’s Disease facility. Many of the service users at St Andrew’s are typically precluded from many care and rehabilitation settings as they present particularly challenging behaviour.
Research Stages
Research was conducted in several stages:
- Working with staff across the two services, incidents of inappropriate sexual behaviour were identified and described.
- Using this, four categories of inappropriate sexual behaviour (verbal comments, non-contact behaviours, exposure and touching others) were created. Each of these was divided into four levels of severity, ranging from ‘mild’ to ‘very severe’ with accompanying written descriptors to enable objective recording of observed behaviour. These were then integrated into the same system of contextual recording used by the OAS-MNR.
- Various statistical properties, including inter-rater reliability and test-retest reliability were determined.
- The scale was then trialled across patients with brain injury and progressive neurological conditions.