The P.L.I.S.S.I.T. Model is a framework often used in sexuality counseling. The acronym PLISSIT is a composite of the first letters of the names of the four levels of the model. The levels describe interaction between the counselor (who could be a nurse with no additional counseling background) and the patient. The acronym refers to:

Permission
Limited Information
Specific Suggestions
Intensive Therapy

Level 1: Permission

The treatment atmosphere must communicate safety, acceptance and openness to the patients. They must sense and receive permission to have and express sexual needs. P.A.T.S. (Positive Attitudes Toward Sexuality) could become a key concept for the hospital in providing sexual health care services. Patients need:

• to be accepted as they are without judgment
• to be equal partners in the helping relationship
• to be accepted with their religious, ethnic and cultural backgrounds
• to be provided with a supportive environment where their sexuality is accept ed as part of their person the freedom of choice to address or not address sexual concerns
• to be heard and listened to effectively advocacy by staff.

Level 2: Limited Information/Education

Once an atmosphere of permission is created, basic specific information must be available to meet patients' needs. This information-sharing process will provid e the patient with a primary education service and a basis for dealing more effe ctively with sexual concerns. Patients need:

• communications skills
• appropriate sexual language to express needs
• basic sex education information
• birth control information/assistance
• effects of illness, medications and disability on their sexual functioning
• access to staff who are capable of responding to specific questions about th emselves and their family
• access to staff who are capable of referring them to helpful resoures
• a resources facility to obtain written and audiovisual education materials.

Level 3: Specific Suggestions

Often the patient will need clearly focused attention in the form of one-to-one assessment and counselling. Through the counselling process a patient will be r eferred to and share and discuss concerns with a skilled staff person comfortabl e with sexuality. The staff member will have participated in education and trai ning and will be able to provide specialized service and support to the patient. Patients need:

• detailed individual education and guidance
• freedom to discuss, as necessary, sexual competence, anxieties, fears and li festyle alternative
• opportunity to understand and explore gender identify issues in light of dis ability
• time to discuss conflicts between themselves and staff/caregivers regarding sexual values and needs
• specific advice on alternative sexual practices and techniques
• to expect appropriate referrals
• birth control information/assistance
• access to counselling involving other family members and/or significant othe r people.

Level 4: Intensive Therapy

Intensive therapy may be indicated in these situations and require referral to trained therapists. Patients need:

• long term intensive support for permanent sexual function disability
• opportunity to consider various sexual alternatives re: use of assistive devices, prostheses and other surgical interventions
• intense therapeutic intervention to address problems of covert overt violent behaviour toward self and/others.