Sexual Health Needs Among Youth in Foster Care: A Grounded Theory Model

Introduction: Youth in foster care are disproportionately affected by STDs and unintended pregnancies. Despite concerted efforts, the sexual health needs of many foster youth remain largely unmet and it is unclear how best to support this population. The current study addresses this gap, guided by the primary research question: What are the sexual health needs of youth in foster care and how can these needs best be met?

Methods: Our team conducted five in-depth focus groups with 16 foster youth aged 16-20 years (M=17.3) and 17 staff professionals serving foster youth. We first interviewed youth, asking them to identify their top sexual health needs and, subsequently, examine their experiences and desired changes. We then used this targeted youth-identified list to explore staff perceptions of youth needs. Data were transcribed verbatim and analyzed using constructivist Grounded Theory methodology. Analysis proceeded through line-by-line open coding, focused coding, axial coding, and selective/theoretical coding to produce a theoretical model of sexual health needs among foster youth.

Results: Analysis revealed a core theoretical category, addressing sexual health needs among foster youth, which is characterized by three supporting categories: reproductive, relationship, and mental health. Reproductive health encompasses HIV/STD prevention and treatment, abortion, adoption, exchange sex, birth control and condom use. When discussing relationship health, foster youth expressed struggling to develop trusting relationships that would support healthy sexual development, knowledge, skills, and safe sex practices. Further, foster youth engage in risky behaviors and are often exploited through sex trafficking, online predation, and dating violence. Lastly, challenges categorized by mental health include suicide ideation and substance abuse. Youth lack critical sexual health knowledge, and the correct information they do have is often not acted upon. Challenges faced by staff and foster parents in addressing these barriers include having enough trauma-informed training, knowing what to discuss with foster youth, and having the opportunity to process their own sexual health perspectives.

Conclusions: The sexual health needs of youth in foster care are complex, expanding well beyond pregnancy and HIV/STD prevention. Foster care professionals and foster parents will require specialized training, supervision, and support in order to elicit and respond to emerging sexual health needs among the youth they are serving. Given the complex challenges faced by this population, foster youth sexual health needs should be addressed holistically, through trauma-informed health promotion focusing on reproductive, relationship, and mental health.