Children engaged with the child welfare system, particularly those within the foster care system, are at particularly high risk of engaging in high risk sexual behavior. Youth in foster care have often been exposed to domestic violence, sexual violence, have been exposed to sexual incidents at a younger age, and have significant experiences of sexual abuse (Dowdell, et al; 2009). Engagement in high risk sexual behavior is a particularly significant area of risk for youth in foster care. Even for those youth who’s primary reason for placement was not sexual abuse, the risk of engagement in high risk sexual behavior remains higher than youth not placed in foster care (James, et al; 2009). Teens and adolescents in foster care have higher general rates of sexual activity than youth not in foster care. Youth in foster care are more likely to have sex for the first time at a younger age; on average, about 7.2 months earlier than their peers not in foster care (Rowland, 2011). Foster Youth also report a higher likelihood of multiple sexual partners, increased STI and STI testing, decreased usage of birth control and STI protection, and a higher rate of pregnancy.(James, et al; 2009) (Rowland, 2011). However, youth in foster care are still provided with the same sexual health education as youth not exposed to abuse and maltreatment. Our systems of prevention and education do not recognize the unique needs of these youth due to histories of trauma, foster care placement, and inadequate service provision. These systems of prevention and education do not provide foster youth with an approach that addresses their unique experience of maltreatment, disrupted attachment and parental support, nor do they recognize the specific triggers that these youth may experience while engaging in general sexual health education. Youth in foster care would benefit greatly from a trauma informed and clinically based sexual health and prevention education program that recognizes the experience and needs of youth in foster care.
Program Activities
Program Activities will include weekly group meetings to engage youth in an educational setting. Mental health and trauma informed clinicians will work with sexual health educators to create group programming that is sensitive to the experience of youth who have experienced or witnessed sexual harm and/or violence and who are lacking in healthy intimate relationships.. This curriculum, which will follow the CDC’s evidence based guidelines for Sexual Health Education (SHE), will recognize possible triggers, areas of disrupted attachment and lack of stability, and promote overall health and well being (Centers for Disease Control and Prevention [CDC], 2021). Group meetings will be followed up by individual clinical support sessions with Licensed Master Social Workers or Licensed Mental Health Counselors to review areas that may impact mental health and will be tailored to individual participants. Youth will receive needed hands on skills and education, but also education and support for their trauma based needs.
Participating youth will also be paired up with a former foster youth to act as a mentor. This mentor will check in with participating youth both before and after scheduled meetings to reviews areas of concern and discomfort, as well as interest, and where more information is needed. Mentorship and support among and between current and former foster youth is important for building positive relationships, increasing strength based skills, and reducing areas of risk. Mentors will share their experiences and will work with youth to develop skills to move past areas of risk based on their own experiences.
The program will assist youth in navigating romantic and sexual relationships in a way that is less risky and more mindful of their past experiences and more likely to break cycles of domestic violence, sexual violence, and high risk sexual activity.
Trauma-Informed Principles
As this program intends to be trauma-informed, we will utilize SAMHSA’s Trauma-informed Principles as a guide (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Our first priority will be to ensure that all staff involved in the program are trauma-informed through appropriate training, supervision, and support. This will include sexual health educators, mentors, and clinicians. Trauma-informed training provided to mentors will be specifically cognizant of the trauma histories of the mentors and their specified roles in the program. The first principle we will utilize, is that of Safety. Program staff will work together to ensure that program settings are physically safe by setting clear rules regarding physical interaction and how to engage around disagreements, and then will work together with each other and with program participants to establish emotional safety for and between participants. This will include individual and group safety planning, conversations around the need for and expectations of confidentiality, and the encouragement of supportive and safe communication including respect and compassion for others experiences. Due to the group nature of the program intervention, and the experiences that participants have in common with regard to foster care placement and early childhood trauma, the principle of Peer Support will be utilized to encourage participants to share their stories, knowledge, and understanding of risk factors with those who have similar lived experiences and to do so in shared and safe space. Program providers will work close with mentors to utilize the principle of Peer Support without re-traumatizing themselves. The principle of Collaboration and Mutuality will be used as the basis between program partnership between staff, program participants, and the mentors to encourage working together, recognizing the “expert” and varied experiences that everyone brings to the program, and that everyone’s roles, experiences, and voice have equal importance. And finally, the program will utilize Cultural, Historical, and Gender Issues to provide sensitivity and support to any cultural differences among participants, as well as supporting varied gender identities and the unique experience therein. Program leaders will focus on the use of gender supportive language, including the use of each individual’s preferred pronouns.
Levels of Social Ecological Model
For this program, we will focusing on two levels within McLeroy’s social ecological model (Simons-Morton, et al, 2011). The primary level that will be focused on is the individual level. The program seeks to address and increase the knowledge of safe sexual health practices of individual foster youth and to do so by providing education and clinical support that will address the individual experiences of each participant, which may include sexual trauma, exposure to sexual or domestic violence, disrupted attachment, or other Adverse Childhood Experiences. By addressing individual needs and experiences through this program, we will increase individual levels of resilience, and improve participants ability to manage intimate relationships in a healthy and less risky manner. Our program will also address the interpersonal level by increasing each foster youth’s access to and membership in a social support network of other foster youth with similar experiences. The group aspect of the program, including the group education, as well as the involvement of mentors, allows each youth to participate in a network of peer support with those who have had similar experiences, and who can continue to provide support and ongoing relationships after the completion of the program. Members of this social support network will also ideally, be able to continue to encourage each other to continue to utilize the skills and knowledge being provided, and allow for “buy-in” among other youth to engage in similar practices.
Project Outcomes
Participants will increase knowledge of sexual health, including preventive measures against sexually transmitted infections and unintended pregnancy, through weekly educational sessions with trained trauma informed sexual health educators. Increased knowledge about overall health and preventive practices will result in lower incidence of sexually transmitted infections, unintended pregnancy, as well as an older age at first sexual encounter and reduced number of sexual partners for foster youth. Weekly contact with clinicians will assist participants with increased awareness of risk factors, processing past trauma that is awakened by project participation, and increase positive coping skills to manage long term affects of trauma. This will allow participants to have the skills to navigate sexual and intimate partner relationships with lower levels of risk, and increase emotional health. Mentors will provide participants with guidance and non-clinical emotional support to increase overall well-being.
References
1. Children in foster care by age group | KIDS COUNT data center. (n.d.). KIDS COUNT Data Center from the Annie E. Casey Foundation. https://datacenter.kidscount.o...2619,122/12988,12989
2. James, S., Montgomery, S. B., Leslie, L. K., & Zhang, J. (2009). Sexual risk behaviors among youth in the child welfare system. Children and Youth Services Review, 31(9), 990-1000. https://doi.org/10.1016/j.childyouth.2009.04.014
3. Dowdell, E. B., Cavanaugh, D. J., Burgess, A. W., & Prentky, R. A. (2009). Girls in foster care. MCN: The American Journal of Maternal/Child Nursing, 34(3), 172-178. https://doi.org/10.1097/01.nmc.0000351705.43384.2a
4. Rowland, M (2011). Sexual Health Disparities Among Disenfranchised Youth. Oregon Health Authority. https://www.pathwaysrtc.pdx.ed...ealthDisparities.pdf
5. What works: Sexual health education. (2021, January 27). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyou...health-education.htm
6. Trauma-informed philanthropy. (2020, December 10). The Scattergood Foundation. https://www.scattergoodfoundat...nthropy/#publication
7. Mentoring youth in the foster care system toolkit. (n.d.). Youth Collaboratory. https://www.youthcollaboratory...ng-youth-foster-care
8. Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
9. Simons-Morton, B., McLeroy, K. R., & Wendel, M. L. (2011). Behavior theory in health promotion practice and research. Jones & Bartlett Publishers.
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