Former Foster Youths' Perceptions of Their Acquisition of Sexual Health Information While in Foster Care

Abstract

In response to disproportionately high rates of pregnancy, sexually transmitted infections, and engagement in sexual risk behaviors, a qualitative pilot study of eight former foster youth was conducted. Semi-structured interviews explored relationships with caregivers, opportunities for sexual health information, and comfort making decisions with current sexual health knowledge. Multiple themes were identified and implications for child welfare systems were discussed.

Full text

Richard A. Brandon-Friedmana, Marea K. Kinneya, Barbara Piercea, and J. Dennis Fortenberryb
a Indiana University School of Social Work; b Indiana University School of Medicine
Former Foster Youths’ Perceptions of Their Acquisition of
Sexual Health Information While in Foster Care
Background
Foster youth and former foster youth have disproportionally
high rates of pregnancy, sexually transmitted
infections, and engagement in sexual risk behaviors
(Ramseyer Winter, Brandon-Friedman, & Ely, 2016)
It has been suggested that systemic barriers may be
present to sexual education for foster youth by this has
not been investigate empirically
Study Participants
Eight young adults between 18 and 26 who were formerly
involved with the foster care system but no longer a
ward of the State of Indiana
Methodology
Convenience sampling through agencies serving former
foster youth in Indiana
Semi-structured interviews lasting from 15 mins to 1 hour
Interviews conducted by two individuals with MSWs
$20 gift card compensation for time participating
Analysis
Six step thematic analysis process as outlined by Braun
and Clarke (2006)
Initial “chunk by chunk” coding followed by theme
development
Initial coding resulted in 308 codes encompassing 54
unique first level themes
Initial themes were collapsed into 2nd and 3rd level themes
Final themes were checked against original data for
representativeness and comprehensiveness
Research Question
What factors influenced former foster youths’
acquisition of sexual health information?
Exercised
Results
Analysis indicated that the former foster youths’ acquisition of
sexual health information was primarily influenced by four
broad factors, each of which had several sub-factors
Power
Removed –“I was forced to get on birth control because
she thought I was having sex, and I wasn’t. Um, it was
just always a bad thing I guess… That was a decision
the foster parents made”
Exercised –“When I decided to get birth control after my
second child, she [DCS worker] just told me to do it
and let her know if I was actually going to do it or not”
Process
Mechanics –“I feel that the times where that [sex] came
up, it was just out of nowhere… I think that kind of
fight or flight response happens and you’re just like
‘abort, abort!’ I don’t want this right now!”
Content –“She told me to use protection, that’s about
it… Not details… but she said when I do make sure
you use condoms, keep yourself safe, stuff like that”
Barriers
Cultural norms –“for whatever reason, whoever’s to blame
–[sex] is just an uncomfortable topic for parents or
foster parents to talk about”
Competing concerns –“Like you can’t talk about sex and
relationships if I’m somewhere beating somebody up,
you know what I mean, I was getting expelled, you
gotta focus on what the problem was”
Lack of positive models –“Being raised in foster homes
and coming from a dysfunctional unhealthy family
home and never really knowing how to do
relationships –or witnessing that –you’re unprepared,
you’re not experienced” Discussion
These findings suggest the importance of recognizing
how the context of the child welfare system affects
foster youths’ acquisition of sexual health information
Power differentials impact how foster youth interpret the
actions of others and how they act in return
Involvement in the child welfare system poses unique
barriers to sexual socialization
Attention need to be focused on how sexual health
information is relayed, not just on the content
Personalized models of interactions were reported to be
more beneficial to the youth
Home Structure
Business Model –
Management –“A lot of these foster parents don’t
care… it’s just a job to them, it’s a paycheck, it’s a
job. Period…. Only one foster home that I feel like
it wasn’t just a job for her, like it wasn’t just
another… house to sell.”
Outcomes –“I mean, her main concern is she didn’t
want any of her foster kids getting pregnant, so
[birth control] was the solution and it didn’t matter
that I wasn’t having sex yet, she didn’t care, she
just assumed I was lying.”
Personal Model –
Trust –“I don’t think the information the they have is
necessarily the game-changer or whatever, I think
it’s whether or not their heart is in it. They can tell
you something, but if this is coming from a
person that you don’t trust, doesn’t trust you –
y’all don’t have a mutual loving connection,
information is just information.”
Intimacy –“She made me want to sit there and listen
or talk about it or learn more, It wasn’t like all the
other foster homes where they just told you what
you wanted to hear and kept pushing –she sat
down and walked through it and anytime there
was a problem, she was there.”
Research Supported by LEAH Training Grant HRSA T 71MC00008