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Reproductive Health and Foster Youth

Reproductive Health and Foster Youth. August 16, 2012 Leslie Starr Heimov, JD, CWLS Children’s Law Center of California Commissioner Anthony Trendacosta Los Angeles County Superior Court. Why We’re Here. Sex and romantic relationships are significant to normal teen development

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Reproductive Health and Foster Youth

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  1. Reproductive Health and Foster Youth August 16, 2012 Leslie Starr Heimov, JD, CWLS Children’s Law Center of California Commissioner Anthony Trendacosta Los Angeles County Superior Court

  2. Why We’re Here • Sex and romantic relationships are significant to normal teen development • Sexual health is a tough subject • challenging for all adults • especially hard in dependency context • Sexual health issues can have major impact on teen health and future plans • Dependency Court can have a powerful role, and is trying to help • You can have a powerful role

  3. Sexual Activity Reported By 6th – 12th Grade Students* Percent reporting behavior Grade in School *Based on data from Project Connect, a study done with 26 LAUSD middle and high schools, 2005 – 2009.

  4. Teen Pregnancy: Consequences • Birth and pregnancy in foster youth: • Foster youth become pregnant 2.5x non foster youth • 2/3 of female foster youth gave birth within 5 yrs of emancipation • Foster youth with 5+ placements more likely to become pregnant • Children of single moms more likely to: • Grow up in Poverty • Become teen moms • Drop out of High School

  5. Sexually Transmitted Diseases Chlamydia Gonorrhea Syphilis Trichomonas vaginalis HPV Hepatitis A, B HIV - fastest growing new diagnosis 20-24 year olds Hepatitis C Herpes

  6. Health Consequences of STDs Infertility Ectopic pregnancy Pregnancy complications and congenital problems Cancer Chronic pain Other chronic conditions or illnesses Emotional and relationship issues: Stigma/Long-term infections DEATH

  7. Special Issues • Sexual orientation and gender identity • LGBTQ youth: • At higher risk for STDs, HIV, pregnancy • Many high risk behaviors • Young *MSM of color at especially increased risk for HIV • Also higher risk for depression, suicide • Abuse • History of sexual and/or physical abuse linked to higher rates of STDs, HIV, and teen pregnancy *(MSM- Men having sex with men)

  8. Sex and Relationships are Significant to Normal Development

  9. Tasks of Adolescence • Achieving independence from parents (“leaving home”) • Adopting peer codes and lifestyles • Acceptance of one’s body • Establishing sexual, ego, vocational and moral identities • Forming caring relationships with others

  10. Normal Development?Easy to appreciate developmental role of other activities

  11. But Sex and Romantic Relationships are Also Normal • Identity formation and validation • Social competencies learned and tested • Training in intimacy, mutual affirmation, communication, negotiation

  12. The Adolescent Brain

  13. So is this normal development?

  14. How about this?Where’s your comfort level?

  15. Sex is a Tough Subject

  16. Challenges Talking About Sex • Both adults and teens are uncomfortable • Incest taboo • Neither wants to see the other as sexual • Adults are (appropriately) afraid of harm • Other normal teen traits problematic with sex • Risk-taking, sense of indestructibility • Impulsive, not thinking of long-term effects • Fear of coercion (especially with girls)

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  18. Challenges Addressing These Issues with Dependent Youth More than half of youth say they prefer getting sexual health information from a parent or trusted adult No one person may be in true parent role: there may be no trusted adult Chaotic lives may disrupt school sex education Possible value conflicts among involved adults History of abuse (sexual, physical) common Abuse and lack of stability may exacerbate regular teen sexual health issues

  19. Extra Significance of Sexual Health for Dependent Youth • Chaotic lives can lead to increased longing for love and need for a sense of belonging • Sexual relationships more likely to be a prime source of validation • Increased risk of being abused or abusive • Need for acceptance can impact sexual health, e.g., getting pregnant to keep a partner

  20. Special Challenges For All of Us In parent role, but not actual parent Limited time to engage with youth Not a trained expert in this area Lack of clear protocols or guidance

  21. But sexual health issues must be addressed… Because adults won’t be there when sexual health risks occur.

  22. Exercise:When did you learn to drive?

  23. How to Use a Condom Correctly • Check package not torn, damaged • Check expiration date • Open carefully, do not use sharp object • Use correct lube (no oil for latex) • After ejaculation, withdraw while still erect • Hold base while withdrawing • Avoid genital contact after removing • Dispose of in trash • Do not re-use • No genital contact before condom put on • Unroll directly onto penis (do not unroll first) • Unroll all the way to base • If no receptacle end, squeeze tip while unrolling • Do not flip over if started wrong side out

  24. What About Abstinence? Q: If I believe in abstinence before marriage, isn’t that in direct conflict with providing condoms to youth? A: No: Lessons from the “Drunk Driving Contract”

  25. Like Any Other Behavior, Sex Takes Practice

  26. CASE STUDY: ALEX Alex is a 14 year-old boy in for regular semi-annual appearance Is uncommunicative

  27. Your Powerful Role

  28. Strengths and Opportunities of Dependency Court Judges, Attorneys and Care Providers Dealing with Sexual Health of Foster Youth Consistent, long term presence, continuity Can enlist support from other court-affiliated professionals and staff to address sexual health issues Use immediate presence with youth to help understand changes in their lives related to sexuality

  29. How to Help Dependency Youth Navigate Sexual Health

  30. What You Can Do (Generally) • Discuss that sex and relationships are a normal part of development • Be a trustworthy adult youth can talk to - or help them identify one. • Express your expectations and commitment • Overall goals specific to sexual development • Build good overall rapport • Express interest in youth as person, their feelings, etc.

  31. What is a Trusted Adult? • One who initiates discussions & listens • Needs to be able to address: • Relationships, dating • Options for the future more attractive than early pregnancy and parenthood • Decision making & goal setting • Family planning and condoms • That youth should have a place they feel comfortable going for reproductive health check-up and information

  32. Effective Communication with Youth • Do: • Stress positive attributes of teen, praise good work • Deliver clear messages • Treat his or her comments seriously, resolve conflicts together • Inform communication by reflecting on your own experiences as a teen • Keep sense of humor • Don’t: • Compare with other teens • Lecture or moralize • Be judgmental or overly critical • Engage in power struggles

  33. Try to Avoid Phrases Like: • “The trouble with you is…” • “How could you do this to me…” • “In my day…” • “You’re wrong” • “That’s a dumb thing to say” (or feel) • “I’m so disappointed in you…”

  34. Expectations and CommitmentRelated to Sexual Health: Some Examples We want youth to be sexually healthy. That means they: Take responsibility Are in relationships where people treat each other with respect Wait to have sex or become a parent because this will interfere with goals and when they’re older they will be better at it We also want youth to be prepared so that: If they do have sex, they don’t get pregnant (or get someone pregnant) They don’t get STDs or HIV They have the accurate information they need Know about condoms Know about family planning options

  35. More Examples:Expectations about Abuse and Violence We want youth to tell a trusted adult - you, their lawyer, CASA, social worker, judge, caregiver, teacher, therapist, etc. if they might be in a relationship that is unsafe. If someone is hurting or threatening them, we want them to know that you can and will help them.

  36. CASE STUDY: JUANITA Juanita is a 17 year-old Latina whose Aunt is her caregiver She lives with her two younger sisters, and three female cousins Clear emphasis on heterosexual norms and traditional ideas of femininity within the household Aunt contacted social worker because she saw Juanita kissing another girl

  37. Express Your Values and Expectations • Youth want guidance and to know what your values are about sex • Take ownership of your values • There are many competing messages (media, friends, etc). You have a special voice and authority: say “this is what I believe” or similar • There is room for your values and the Court’s efforts • There is no substitute for the one-on-one contact you can provide • Do what is comfortable for you • You don’t have to weigh in on sexual health, but YOU can be a positive influence!

  38. Are you ready? • In Los Angeles dependent youth will now have access to materials and resources including: • Brochures on various topics, including sexual health • Cards to help access Hookup Weekly text messages promoting safe sex • Condoms • SWAG • Youth who choose to take materials or condoms will leave court with the materials in a brown paper bag.

  39. We could never do that in …. • Colorado • Minors may consent to all reproductive health services but notice required to at least one parent for abortion • Illinois • Some minors may consent to contraceptive services; minors may consent to STI services & prenatal services; notice required to at least one parent for abortion

  40. Or in……. • Florida – Judge Cohen & Judge…. • Some minors may consent to contraceptive services; minors may consent to STI services & prenatal services; notice required to at least one parent for abortion • Connecticut • Minors may consent to STI services and abortion but not contraception unless they are married • DC, New Mexico • Minors may consent to all reproductive health services

  41. Georgia Minors may consent to reproductive health care, but for abortion at least one parent must be notified, and doctor may (but is not required to) choose to notify parents of STI treatment Michigan Minors may consent to prenatal and STI treatment; doctor may (but is not required to) choose to notify parents. Parental consent required for contraception (unless married) and abortion. information go to: www.guttmacher.org/statecenter/spi/bs/spib_OMCL.pdf For additional state specific

  42. Texas and Utah Only married minors may access their own contraceptive services, but no state funds may not be used to fund the services. Minors may consent to their own STI and prenatal care; but in Texas the doctor may but is not required to, choose to notify parents of prenatal care. Parental notice and consent required for abortion. For more detailed state specific information go to: www.guttmacher.org/statecenter/ For additional state specific

  43. Getting Started • Data, Data, Data • Find a champion • Judge • Child Welfare Leader • Advocacy Organization (including youth led organizations) • Elected Official • Community Leaders • Build Relationships • County or State Department of Health • Free Clinic • Adolescent Health Expert • University Department of Public Health

  44. Questions?? • #1 Juan (age 12): • Juan returns from court and says, “I got some condoms today at the court - what are they for?” • #2 Danielle (age 15): • Danielle fills her bag with brochures and condoms but says nothing. • #3 Alex (age 16): • Alex says, “I got 10 condoms at court and I’m going to use them all tonight!”

  45. Contact Us Leslie Heimov heimovl@clcla.org www.clccal.org 323-980-5762 Commissioner Trendacosta atrendac@LASuperiorCourt.org 323-526-6446

  46. Resources for Professionalspage 1 of 2 • National Council of Juvenile and Family Court Judges, www.ncjfcj.org (775) 784-6012 • “When You Decide,” A Judge’s Guide to Pregnancy Prevention Among Foster Youth (includes checklists) • Critical Judgment: How Juvenile and Family Court Judges Can Help Prevent Teen and Unwanted Pregnancy • Ten Things Every Juvenile Court Judge Should Know About Trauma and Delinquency • Public Health Institute, www.phi.org (510) 285-5500 • Sex Education and Reproductive Health Needs of Foster and Transitioning Youth in Three California Counties • No Time for Complacency, Sexual Health Needs of California’s Foster and and Transitioning Youth, Spring 2009

  47. Resources for Professionalspage 2 of 2 • California Adolescent Health Collaborative (a PHI project), www.californiateenhealth.org (510) 285-5712 • Promoting the Sexual and Reproductive Health of Adolescents in Foster Care • National Center for Youth Law, www.youthlaw.org (510) 835-8098 • Consent to Medical Treatment for Foster Children: California Law A Guide for Health Care Providers, December 2008 • L.A. County Department of Public Health • An Epidemiologic Profile of HIV and AIDS in Los Angeles County 2009, http://publichealth.lacounty.gov/hiv • Los Angeles County Sexually Transmitted Disease Morbidity Report, 2010, http://publichealth.lacounty.gov/std/reports

  48. Resources for Parents and Caregivers • The National Campaign to Prevent Teen and Unplanned Pregnancy, www.thenationalcampaign.org(202) 478-8500 • 10 Tips for Foster Parents to Help Their Foster Youth Avoid Teen Pregnancy • Children Now, Talking with Kids About Tough Issues, www.childrennow.org/index.php/learn/talking_with_kids (510) 763-244

  49. Resources for Youth • Teen Source, http://teensource.org • Planned Parenthood, http://www.plannedparenthood.org • MTV’s It’s Your Sex Life, http://www.itsyoursexlife.com • www.HaveSexStandingUp.com • Sex Etc. (by teens for teens), http://www.sexetc.org • It Gets Better Project (for LGBTQ youth), http://www.itgetsbetter.org • Go Ask Alice (Columbia University), http://www.goaskalice.columbia.edu • www.DontThinkKnow.org • www.bedsider.org • LA County STD Hotline: 800-758-0880 • HIVLA – testing and treatment resources in LA, http://www.hivla.org • Text CLINIC +ur zipcode to 61827 to find clinics near u

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