Learning About Healthy Relationships: A Research Study Update

Research Inspiring Action: The Texas Foster Youth Health Initiative’s Innovative Approach To Sexual Education Programming & PracticeBy Allie Long & Barbara Ball Ph.D., LPC-AT

Last May, we got the chance to talk with Dr. Barbara Ball about a new exploratory study called Learning About Healthy Relationships. In our last conversation (which you can read here), we chatted about the importance of understanding how and what youth in foster care learn about sexuality and relationships.

For this month’s edition of Connecting the Dots, we are focusing on the ways in which social work research and practice are being used to better support youth in foster care as they explore their sexuality and develop relationships. We’re excited to share several important updates from Dr. Ball about this study, and how these research findings are already informing our programs in practice.

Can you tell us a little bit about where this study is currently and what has evolved since our last conversation?

Dr. Ball: In the last several months, I completed interviews with 27 young adults who had lived in foster care. These conversations were driven by our desire to more holistically understand what was going on in their lives and how growing up in foster care impacted their exploration of relationships. More specifically, our questions were designed to explore what young adults had learned about sexual and dating relationships, and the ways in which they’d either felt supported or unsupported by the adults in their lives. We’ve already completed a big chunk of our data analysis, and we’re just about to write a manuscript to publish (more on that to come later).

In many ways, this study came at a very exciting time for our institute. This past September, while in the process of analyzing data for this study, we announced that we were the recipients of a $5.4 million-dollar grant to lead the Texas Foster Youth Health Initiative (TFYHI). This is a three-year project that builds relationships across child welfare and adolescent health systems to develop and test cutting-edge interventions. Information and skill-building efforts will target youth and their caregivers to promote brave conversations about sexual health, pregnancy prevention, and healthy relationships, as well as increase capacity in organizations and communities. To a large extent, TFYHI has been inspired by interviews from this research study. The voices of these 27 young adults are informing our upcoming trainings and giving us a greater understanding of how we can support youth to feel connected, safe, and empowered so they can make informed decisions about their sexual health and relationships.

What are the top 3 findings from your research on Learning About Healthy Relationships?

Dr. Ball: Across all of our interviews, we discovered the following trends:

1. Abusive, or “toxic,” dating relationships were a highly prevalent experience for youth in care—about ¾ of the participants had experienced some form of emotional, physical or sexual dating violence in their lives. Many participants reported that abuse had been such a common occurrence in their lives that it had begun to feel normal or acceptable for them. One participant stated, “When I picked these men, they talked to me like trash and treated me like trash because that’s what I was used to and that’s what I allowed. That’s what I was comfortable with.”

Many participants first experienced abusive dating relationships during their high school years when they felt isolated and yearned for emotional connection. Several of them dated older partners, jumped into relationships quickly, and held on to relationships even when they became abusive. Others encountered violence and abuse in moments when they were most vulnerable: when they ran away from placements, were homeless, or got involved with substance use.

Many of the study’s participants described feeling unprepared to handle life after aging out of care, which left them vulnerable to crises and sexual exploitation, and some faced the removal of their own children. Yet moments of crisis were also an impetus for change. With the exception of two participants, the young adults reported being in a better place in their lives and relationships at the time of the interviews. They expressed a strong desire to change and grow, which often included seeking therapy, cutting ties with “toxic” people in their lives, focusing on themselves and their life goals, and finding supportive role models. Participants who went off to college mentioned the importance of their larger networks of support, including peers and friends who had NOT gone through trauma and abuse, which helped to provide a broader perspective of what relationships might look like.

2. The young adults in this study shared that their experiences related to sexuality and relationship education had largely focused on warning signs and risk factors. Some participants acknowledged that learning to recognize the warning signs of abusive relationships was an important step toward making changes in their lives. For others, the focus on warning signs and risks induced even more fear of intimacy. “If I date somebody, I just immediately start looking for red flags,” said one participant. “I may be overly cautious, and perhaps I’ve been protecting myself so much, that I try to avoid relationships just because I don’t even want to approach this issue.”

By focusing primarily on warning signs of abuse and the risks of being sexually active, caregivers and child welfare professionals are missing the opportunity to model both healthy and trusting relationships, and build skills for communication, boundary setting, and negotiating consent. The study participants overwhelmingly expressed that they wanted opportunities to better understand what a healthy relationship can look like.

For many of the young adults, the thought of healthy relationships seemed like a fantasy at first; a fairy-tale too good to be true. One participant stated, “It took a lot of trials with bad relationships for me to figure out how it’s supposed to look. What would help other young people is to inform them that it really can be better.”

3. More than anything, youth really wanted to connect with someone the way they might connect with an ideal parent or peer mentor. They wanted the opportunity to talk about their experiences and struggles without feeling like others were assuming the worst of them just because they had grown up in an environment of abuse or neglect. These youth thrived when they encountered supportive adults, older siblings, and friends who affirmed that they were worthy of love and being treated respectfully. One participant told us that the thing she wanted to hear most was, “Don’t settle, you are beautiful.” Beyond education, information, and advice, youth who experience foster care wanted someone to sit down with them and make them feel both connected and loved. “I don’t really think it’s an advice type thing,” explained one participant. “I think what really helps people in that situation is having somebody care about them.”

Participants shared their understanding of the foster care system as being a structure focused on keeping youth safe and breaking the cycles of abuse. However, such focus sometimes triggered protective and controlling behaviors on the part of caregivers and the system. Whereas young people typically spend their formative years exploring and building skills for romantic relationships, these youth growing up in foster care felt stifled and isolated, as if they were living in a protective bubble. There were simply too many restrictions on normal social activities. Once out of care they felt suddenly unprepared.

Now that you’re reaching the end of your study, how do you think Learning About Healthy Relationships will impact future research?

Dr. Ball: The Learning About Healthy Relationships study has helped to shape many foundational components of the Texas Foster Youth Health Initiative. There is a clear need to address sexual health in the context of healthy relationships, and to develop interventions that build skills and resilience rather than just focusing on risks or how to react to crises.

Our conversations with youth have shown us the importance of providing sexual health education through a trauma-informed lens that emphasizes healthy relationships and skill building instead of fear-based tactics.

LGBTQ+ youth are overrepresented in care, and these youth especially need a safe place to both explore and express their identities and sexual orientation. Because of this, it’s absolutely necessary to look at sexuality, gender and relationships from an inclusive and positive lens in the overarching conversations around sexual health.

We have the opportunity to intervene by supporting, guiding, and training caregivers on building trusting relationships with the youth in their care, engaging in conversations about sexuality, gender, and relationships, and providing a sense of normalcy. In its most basic sense, youth need strong relationships with compassionate people who are there for them.

We’ve already begun translating findings from this study into upcoming TFYHI trainings, which you’ll hear more about in the coming months.

To read more on the “Learning About Healthy Relationships” study and Dr. Ball’s body of work, click here. If you’d like to learn more about the latest from the Texas Foster Youth Health Initiative, click here.