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Pastoral Care: Sexual Health Assessment Checklist

To complete this form before printing it:

Reporting requirements Yes No Don't Know Plans for Improvement
Do you know the state law about when clergy must violate confidentiality to: Prevent a crime?
Report a crime?
Report child abuse?
Report child pornography use?
Protect someone from suicide?
Training Yes No Don't Know Plans for Improvement
Have you had training on counseling on sexuality issues in general?
Have you had training on premarital counseling?
Have you had training on working with couples with relationship issues?
Have you had training in divorce mediation?
Have you taken a course on pregnancy options counseling?
Have you taken a course on working with sexual abuse survivors?
Do you know the PLISSIT model?
  Yes No

Feel Comfortable Without
Additional Training

Plans for Improvement

Have you had specialized training in these areas: Adolescents?
Bisexual adults?
Couples counseling?
Couples affected by infidelity?
Couples during pre-marital counseling?
Couples struggling with infertility or ART's?
Disabled persons?
Intersex individuals and families with an intersex child?
Families with gender variant children?
Families with LGB children/grandchildren and families with LGB parents/grandparents?
Gay and lesbian adults?
People involved in alternative sexual communities? (i.e., kink, bdsm, online role playing)
People with cognitive disabilities?
People with HIV/AIDS?
People with mental health issues?
Polyamorous individuals/families?
Transgender adults?
Young adults 18 - 24?
LGBT youth?
Survivors of sexual abuse and/or domestic violence/sexual assault?
Persons convicted of sexual offenses?
  Yes No Plans for Improvement
Do you have up-to-date reading lists to give to congregants on these topics: Adolescence?
Bisexuality?
Couples Enrichment?
Infertility or ART's?
Sexuality and Disabilities?
Intersex
Gender variant children?
LGBT issues?
Alternative Sexual Communities? (i.e., kink, bdsm, online role playing)
HIV/AIDS?
Polyamory?
Transgender
LGBT youth?
Sexual abuse and domestic violence/sexual assault?
  Yes No Don't Know Plans for Improvement
Do you have outside experts for referrals for: Adolescents?
Bisexual adults?
Couples Affected by Infidelity?
Couples during pre-marital counseling?
Couples struggling with infertility or ART's?
Disabled persons?
Intersex individuals, including families with an intersex child?
Families with gender variant children?
Families with LGB children?
Gay and lesbian adults?
People involved in alternative sexual communities? (i.e., kink, bdsm, online role playing)
People with cognitive disabilities?
People with HIV/AIDS?
People with mental health issues?
Polyamorous individuals/families?
Transgender adults?
Young adults 18 - 24?
Couples?
LGBT youth?
Survivors of sexual abuse and/or domestic violence/sexual assault?
Sexual offenders?
Referral Lists/ Networks / Network Yes No

Plans for Improvement

Does your referral list include: Certified Marriage and family therapists?
Certified Sexuality counselors and therapists?
Sex Abuse Treatment Specialists?

Pastoral Care: Assessing Sexual Health

For more information contact safecongregations @ uua.org.

This work is made possible by the generosity of individual donors and congregations. Please consider making a donation today.

Last updated on Wednesday, May 23, 2012.

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