Stakeholder perceptions of barriers and facilitators to sexual health discussions between foster and kinship caregivers and youth in foster care: A qualitative study

Purpose: Youth in foster care are more likely to contract a sexually transmitted infection (STI) and become pregnant than other youth, who have not been in foster care. This study explored stakeholder perceptions of barriers and facilitators to conversations about sexual health between foster/kinship caregivers and youth in foster care, with the goal of developing a brief, scalable sexual health training for caregivers. Methods: We conducted individual phone interviews with twenty stakeholders from a variety of occupations that work closely with foster and kinship caregivers in 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 facilitators in having these conversations, and staff members’ comfort level in having these discussions with youth in foster care. We coded and analyzed transcripts using Thematic Analysis technique. Results: Themes emerged around three main categories: 1) barriers to sexual health conversations with youth in their care, including caregivers’ religious and personal beliefs impeding youth access to accurate sexual health information and crucial medical services, staff and caregiver lack of sexual heath knowledge, caregiver and/or youth discomfort in engaging in sexual health conversations, and a lack of mandatory training for caregivers and staff on sexual health; 2) facilitators to sexual health conversations with youth, including open and nonjudgmental communication between youth in foster care and caregivers, and engagement in deliberate relationship-building activities with the youth; and 3) recommendations for content and format of a training for caregivers and agency staff to address barriers to conversations, such as making trainings mandatory and in-person. Conclusions: Stakeholders identified several barriers and facilitators to sexual health conversations and viewed conversations between caregiver and the youth in foster care as essential to the youth's wellbeing. Clear guidance from child welfare agencies and caregiver-oriented trainings that include straightforward information and skill-building strategies could help to mitigate these barriers and related health disparities.