Let’s talk about it: Exploring how to educate and support foster youth on dating, sexuality, and health

By Allie Long & Barbara Ball, Ph.D., LPC-AT

Happy teen coupleWhen we talk about older youth in foster care, and especially about youth who are aging out of the foster care system, a lot of conversations focus on the negative outcomes that these teenagers experience. Research highlights the high rate of teen pregnancy and the risk for dating and sexual violence and exploitation among foster youth.  In Texas, females in foster care are five times more likely to get pregnant than their same-age peers, and more than half of teen girls who age out of care or extend their time in care will become pregnant before they turn 20.[i]

May is both National Foster Care Month, which recognizes the parents, professionals, and community members involved in helping foster youth find permanency, and National Teen Pregnancy Prevention month (NTPPM), which is traditionally a time to acknowledge the historic declines in the rate of teen births in the US. At our institute, we believe that there are many components to health and sexuality that are necessary to include in our conversations around teen pregnancy for youth who have been in foster care that go far beyond a single sex talk.

Last year, Dr. Barbara Ball joined the TXICFW team as one of our Senior Research Associates. Dr. Ball came to the institute after working for 15 years at the SAFE Alliance, where she developed program materials, curricula and trainings, and coordinated the evaluation of Expect Respect, a comprehensive program to reduce dating and sexual violence and promote healthy relationships.

Building on her previous work in the realm of healthy relationships, Dr. Ball is currently working on a new exploratory study about how youth living in foster care explore sexuality, dating, and relationships. This month, we sat down with Dr. Ball to highlight the multifaceted work being done to better understand how and what youth in foster care learn about sexuality and relationships.

Can you tell us a little bit about the purpose behind your study called “Learning About Healthy Relationships?”

Dr. Ball: When I looked at what’s currently being done to educate foster youth on sexuality and relationships, I noticed several things.

At our institute, we have conducted work on adolescent sexual health for years. Most recently, we completed project SHINE: positive Sexual Health for youth IN out-of-home Environments.  We have learned that youth in foster care need trauma-informed sex ed programs that help them develop positive expectations for relationships and sexual health.  Too often, sexuality education, healthy relationship education, and violence prevention are taught in separate programs, when in real life they are intertwined.

Secondly, sexual health education is typically provided in school, which is very often minimal. We know that many foster youth don’t regularly attend school due to placement changes, skipping classes, or dropping out of school. If they’re not regularly attending school, they’re likely not receiving important information about their sexual health. Even for the youth who are able to attend sex education while in school, the curriculum is typically focused on how to prevent STIs and pregnancy without practicing important relationships skills, such how to set boundaries, ask for consent, or communicate about birth control.

Thirdly, youth growing up in foster care often miss out on conversation with trusted adults about expectations for healthy relationships and sexual health. While they are surrounded by adults, it is not clear whose responsibility it is to talk with them about navigating relationships.

All of this combined prompted me to start this study and talk to young adults with lived foster care experience to understand what information and messages they get about sexual health and relationships.

Why is it important to study how youth growing up in foster care explore dating and sexual relationships?

Dr. Ball: Youth who grow up in foster care not only deal with experiences of maltreatment and neglect and the removal from their birth families, but also with frequent placement changes and repeated disruptions of relationships with caregivers, peers, and school. I’ve worked with a lot of youth who have been exposed to violence, and something that we commonly see is the toll that violence and trauma can take on a young person’s development. If children do not have caregivers in their lives who are able to create a safe space and are attuned to their needs, how will they learn to express their feelings, how will they learn to set healthy boundaries?  The idea that you can CHOOSE to say “no,” set a boundary, or CHOOSE to be with people who respect you is unfamiliar for many youth who have experienced trauma and not something they have a lot practice with. Many youth find it difficult to envision relationships that are caring, loving and respectful. In addition, youth in foster care often experience a profound loss of control and agency in their relationships when placement decisions occur without their input and consent. So it is really important to think about what it means to provide trauma-informed sexual health education and how we can incorporate much more thoughtful conversations around consent and help youth build skills to express themselves and communicate assertively.

What’s something you have learned from your study so far?

Dr. Ball: The “Learning About Healthy Relationships” study is in its early stages, but hearing about the extent of loss and isolation that many teens in the foster care system experience is striking to me.  Peer relationships play an enormously important role in the lives of typical adolescents, so learning how disconnected former foster youth felt growing up, has been eye opening and troubling.  Isolation can be the result of frequent placement changes that disrupt schooling and peer relationships, the stigma attached to being a “foster child,” or restrictive placements that limit normal, age-appropriate social activities. These are just some of the many reasons why foster youth report feeling so profoundly disconnected. The desire for connection, love, and relationships is huge for foster youth, as it is for all of us. And if you’re unable to form bonds, there’s such a void to fill. Experiencing that void might also be one of the reasons to quickly engage in the relationships without being able to step back and consider whether they’re healthy or safe.

How do you hope to change policy, practice, or discourse related to romantic and intimate relationships for youth living in foster care?

Dr. Ball: I’m really interested in finding ways to increase conversations about healthy relationships and sexuality for youth growing up in foster care. Youth need on-going dialogue with trusted adults about how to navigate relationships, yet our research indicates that these opportunities are lacking.  Youth also need access to sexual health education that is trauma-informed, medically accurate, and that empowers them to make decisions and choose healthy and safe relationships. Some of the recommendations may include:

  • Empowering parents and professionals (including CASA and caseworkers) in foster home settings to have Brave Conversations with youth about healthy sexuality and relationships. This can often seem uncomfortable for adults, whether it’s because they don’t know the youth well enough or the youth are staying in the home for a limited period of time. By providing caregivers with better training, we could be providing foster youth with greater systems of support. Everyone needs somebody who can sit down with them and understand what’s going on, know all the drama of dating and relationships, and talk about it together, like a parent would.
  • Enhancing the content and delivery of sexual health programming. We could make programming more collaborative, interactive, and creative so that youth have an opportunity to express their voice, hear from each other, and consider different perspectives and expectations for relationships. Peer educators could make content more personal and relevant and help develop creative ways of sharing information about healthy relationships.
  • Integrating conversations about healthy peer and dating relationships in the work that is already being done to promote “normalcy” for youth in foster care. Youth need to have opportunities to have age-appropriate social activities with peers and dating partners and build social networks, yet many youth still describe their placements as restrictive. There may be opportunities for developing training and best practice guidelines for how foster parents and congregate care settings can support the social-emotional development of youth.

“Learning About Healthy Relationships” is in its early stages, but we are excited to follow Dr. Ball’s research as it continues to grow. To view our pre-existing work in adolescent sexual health, click here, and to learn more about Dr. Ball’s work, you can visit her page.

Click here to see our Learning About Healthy Relationships page

[i] Texans Care for Children & The Simmons Foundation (2018). Fostering Healthy Lives: Strategies to prevent teen pregnancy in foster care and support teen parents in foster care. https://static1.squarespace.com/static/5728d34462cd94b84dc567ed/t/5ad4aa001ae6cfce64d7316f/1523886600659/fostering-healthy-texas-lives.pdf