5. Providing Access to Care and Removing Barriers

Focus Areas

❒ The reproductive and sexual health rights of youth in care and the responsibility of staff to uphold those rights;
❒ A list of the common complaints and grievances related to barriers to care and how to reduce those barriers for youth;
❒ Storage and personal belonging policy and protocol;
❒ Transportation and appointment procedures;
❒ A statement of expectations of staff to communicate with youth about healthy sexual development and to teach self-love;
❒ Examples and procedures for sensitive conversations between staff and youth;
❒ A statement prohibiting staff from confiscating vibrators, dildos, or other personal belongings of the youth;
❒ Protocol for ensuring youth access to contraceptive counseling and contraception, and prohibition of confiscation of birth control from youth;
❒ Protocol for responding to pregnancy disclosure, including attending child and family team meetings, referral to home visitation if no referral is made by county child welfare agency, and follow-up care and support; and
❒ Protocol for staff support of expectant and parenting youth access to prenatal and postnatal care, financial and education assistance, parenting classes and other timely appointments .

Finding the Right Services
• Promote safety and well-being
• Youth-centered, trauma-informed, individualized care
• Harm reduction when needed—you may not be able to get youth to agree to everything at once, focus on primary safety first
• Sexual and reproductive health is only part of an overall wellness plan
• Offer options to empower youth to decide for themselves
• Foster care nurses can be very helpful
• Keep in mind the specific individual and their unique needs
• Consider transportation and convenience
• Ask who the youth prefers to work with
o Male or female doctor
o Someone with special training
o Some areas will have limited options, so it’s good to go over how to get what they need (e.g. take a written list of needs, bring someone with them, etc.)
• When searching for services, keep confidentiality in mind especially in smaller communities

Provide timely transportation to health-related services.
Caregivers and foster care providers are required by state law to provide timely transportation to health related services. Organizations should ensure sufficient staffing for transportation assistance. Many reproductive health services are time sensitive (e.g., emergency contraception),
therefore, transportation must be provided in a timely manner in order to meet the requirement. Transportation must be provided regardless of the organizational or staff religious beliefs or preferences.

Permit youth to obtain sexual and reproductive health care services from the provider of their choice.
Youth do not need permission from anyone, including parents, caregivers, staff, or the court, to obtain sexual and reproductive health care services. While an STRTP or GH may have contracted or preferred providers, youth have the right to continue to receive services from their previous provider or a new provider of their choice. Policies should reflect Licensing Standards and be clear that staff may not refuse to facilitate transportation to services because of the youth’s choice of provider.

Provide sufficient storage space for each youth’s personal belongings, including reproductive and sexual health care items.
Licensing Standards require youth be provided with closet, drawer, personal storage space, furniture, equipment and products necessary for care and maintenance of personal hygiene, clothing and personal belongings, and reproductive sexual health care products, including contraception and the morning-after pill. Youth have the right to store their personal belongings and to keep their contraception. Staff should be familiar with menstrual and other personal hygiene products that are developmentally and culturally appropriate and gender-affirming. Organizations should ensure staff are familiar with the various types of contraception so that it is not mistakenly confiscated. Staff should allow youth to express their gender identity with their appearance, dress, clothing, products, personal belongings, and behavior as required in Interim Licensing Standards.