Stakeholder perceptions of strategies and barriers to sexual health discussions between foster and kinship caregivers’ and foster youth: A qualitative study to inform the development of a sexual health caregiver training

Abstract

BACKGROUND: Foster youth are more likely to contract a sexually transmitted infection (STI) and become pregnant than non-foster youth. This study explored stakeholder perceptions of barriers and facilitators to conversations about sexual health between foster/kinship caregivers and foster youth, with the goal of developing a brief, scalable sexual health training for foster and kinship caregivers. The perspectives of foster and kinship caregivers were also explored in a prior study. METHODS: Twenty stakeholders from a variety of occupations that work closely with foster and kinship caregivers participated in individual interviews by telephone. Interviews were performed between October 2015 to February 2016. Participants were recruited from three different locations including New York, NY, Seattle, WA and Los Angeles, CA. Stakeholders were asked semi-structured open ended questions regarding their thoughts on a caregiver’s role in discussing sexual health, barriers and strategies in having these conversations, and staff members’ comfort level in having these discussions with foster youth. Transcripts were coded by two coders using Theoretical Thematic Analysis technique and ATLAS.ti software. RESULTS: Various themes emerged based on the description of barriers and facilitators. Most stakeholders indicated that caregiver beliefs and values about sex were sometimes a barrier: (1) open and honest communication between caregivers and foster youth; and (2) foster youth access to accurate sexual health information and crucial medical services. Other barriers identified include staff and caregiver lack of sexual heath knowledge, youth discomfort in engaging in sexual health conversations, concern about triggering trauma or an allegation of misconduct, and the lack of mandatory training for caregivers and staff on sexual health. Stakeholders also described facilitators to sexual health conversations including nonjudgmental communication between foster youth and caregivers and engagement in deliberate relationship-building activities with the youth. The majority of stakeholders expressed the importance of caregivers discussing sexual health with foster youth and serving a crucial role as a point person to have these conversations and recommended mandatory training for both caregivers and child welfare staff. Participants also provided recommendations on content and format for a caregiver training. CONCLUSIONS: Stakeholder interviews assisted in identifying barriers and facilitators to sexual heath discussions between foster youth and caregivers. Data from our stakeholder participants provide a critical perspective for developing trainings for caregivers and other strategies to decrease high risk behaviors and improve reproductive health among foster youth.