Developmentally Appropriate Approaches to Discussing Sexual and Reproductive Health Rights with Foster Youth

State law requires foster care case managers, which includes social workers and probation officers, to annually engage with foster youth, starting at age 10, to promote recognition of sexual and reproductive health needs and access to sexual and reproductive health care. This topic can be challenging to address due to the developmental differences between youth of different ages and different lived experiences, the impact of traumatic childhood experiences on adolescent development and sexual behaviors, and the
attitudes and concerns that adults—including case managers—may have related to adolescent sexuality.

The intention of this topic is to provide background information about adolescent development and some suggested trauma-informed approaches to meet the requirements of the law in an age-appropriate manner. This guide is organized into three developmentally appropriate information sheets for tweens/ early adolescents, middle adolescents, and transition aged youth/young adults.

Utilize a Trauma-Informed Approach
The experience of trauma, an experience shared by almost all youth and young adults in foster care, has a significant impact on child and adolescent development and behavior. In general, exposure to trauma results in a young person prioritizing skills, behaviors, and adaptations that help them to survive their environment in an attempt to meet their physical, emotional, and relational needs. These coping approaches may be maladaptive and can result in challenging, risky, and sometimes dangerous behaviors.
On the following pages, you will find general background information on the characteristics of the three stages of adolescent development, as well as suggested conversation starters you can use to frame your discussion about sexual and reproductive health rights with foster youth and young adults at different ages and stages of development.

When reviewing the following pages, remember the impact of trauma on
adolescent development, including:
• Internalizing (more prevalent in younger adolescents) and externalizing (more prevalent in middle and late adolescents) reactions
• Premature separation or age-inappropriate dependence
• Risk for affiliation with a peer group with negative behaviors
• Risk for engaging in risky sexual behaviors, substance misuse and self-harm
• Attempts to control self and environment, sometimes through dysfunctional approaches
• Difficulty forming trusting relationships
• Failure to develop age-appropriate coping strategies
• Development of a negative self-identity

Also, keep in mind that trauma-informed relationships that are supportive, consistent, and reliable—such as the relationships that case managers, care givers and facility staff can form with foster youth and young adults—can be healing experiences that support healthy development.

Sensitive, developmentally appropriate, open communication approaches to the topic of sexual and reproductive health (SRH) will facilitate meeting the needs of young persons you serve and the mandates of the law. SRH recommendations from frequency and types of medical services to methods of contraception change rapidly, so make sure that you are up to date in your own knowledge base.

Recommended approaches to addressing SRH needs with young persons you serve:

• Explore your own attitudes and biases related to adolescent sexuality
• Prepare yourself by updating your knowledge base about SRH. Don’t feel like you have to be the SRH subject matter expert. It is okay to say “I don’t know – what do you think or let’s find out.”
• Be familiar with the law and understand minor consent and confidentiality rights related to SRH (see lesson 2)
• Be aware of the impact of trauma on young persons you serve, and of secondary or vicarious trauma on you

• Use trauma-informed approaches to opening, engaging in, and following up on discussions of SRH:
  1. Work to earn and maintain a trusting relationship. Discussing confidentiality and situations that might result in the need to breach confidentiality is an essential step in building trust.
  2. Acknowledge the difficulty of the topic and recognize trauma-symptoms that may interfere with the discussion.
  3. Ask permission! The young person may not be ready to discuss SRH needs when you had planned and may need additional time or sessions to have the discussion.
  4. Utilize a strength-based approach, building on what the young person already knows,
  5. Recognizing their attempts to protect and manage their SRH, and supporting their desires and choices.
  6. Individualize your approach to meet the needs of the young person you are working with.