Sexual and Reproductive Wellness for Youth in Foster Care

1. Sexual and Reproductive Wellness for Youthin Foster Care

2. Why This Training? Segment 1

3. Introductions • Name • Department or Agency • Role related to Sexual Wellness in Foster Care Activity: Group Agreements

4. Learning Objectives The law is pretty explicit about what our learning objectives are today: • Knowledge • Skills • Values Read Learning Objectives in Trainee Guide 4

5. 5

6. Foster Youth Sexual Health Education Act (SB 89) • Specifically, youth and non-minor dependents (NMD) aged 10 or older • Receive their comprehensive sexual education in middle and high school • Specifies what additional information young people in care receive • New documentation in case plan • Mandates training for case workers, judges, and caregivers 6

7. Foster Youth Sexual Health Education Act (SB 89) Training Requirements for Case Workers • Rights of youth and non-minor dependents • Case plan documentation • Duties and Responsibilities of case workers and care providers • Guidance on how to engage with young people about healthy sexual development and reproductive health • Current contraception methods • How to select appropriate resources, information, and services 7

8. “Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors.”  World Health Organization 8

9. Activity What We Bring 9

10. Sexual and Reproductive Wellness • Deliberate terminology • Whole person’s lifetime wellness not just prevention • Deeply rooted in the core goals of child welfare—safety, permanency, and well-being. 10

11. Sexual Wellness in Foster Care • Sexuality is a normal part of human development beginning at birth • Sexual activity itself does not necessitate undue risk • Foster youth are more vulnerable than peers their same age: • Lack of close adult relationship/parent guidance • Trauma history • Commercial sexual exploitation • Institutional barriers 11

12. Pregnancy 12 Midwest Study Courtney, et. al., 2007

13. Unintended Pregnancy Of the foster youth that experienced pregnancy, most reported that it was not intentional • 66.3% of young men • 70.7% of young women CalYOUTH, Courtney et. al., 2016 13

14. Big Picture of STIs 14

15. STIs in Foster Care Child Trends, 2017 15

16. Your Work Matters 16

17. Sexual and Reproductive Wellness Rights Segment 2

18. Sexual Health as a Human Right “Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity… For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” --World Health Organization 18

19. California Minor and Non-Minor Dependents age 10+ are guaranteed the right to: • Have their rights explained in a manner they understand • Health care services, including sexual + reproductive care • Confidentiality • Reasonable and Prudent Parenting Standard

20. Explaining Rights to Young People When: • at age 10 and older • upon entering Foster Care • at the time of each placement change • at least every six months after most recent of these Repetition is okay, helps with retention Best practice: follow up other than these required times to check for comprehension and questions

21. Explaining Rights to Young People How: • Age appropriate • Developmentally appropriate • Medically correct • Factual • Objective Best practice: trauma informed, strengths based, culturally sensitive, LGBTQ inclusive, and positive youth development perspectives

22. LGBTQ and Gender Non-Conforming Youth • Same rights as all other foster youth and NMDs. • Right to be placed and live in out-of-home care according to their gender identity regardless of gender or sex listed in their record • Access to gender-affirming medical and behavioral health care • Adequately trained caregivers and child welfare personnel • Fair and equal access and freedom from harassment and discrimination

23. ACTIVITY Know Your Sexual and Reproductive Health Rights Brochure—Page 1 Item #1: Youth have the right to have their rights explained in a way they can understand.

24. Reasonable and Prudent Parenting Standard “Careful and sensible parental decisions that maintain the child’s health, safety, and best interests while at the same time encouraging the emotional and developmental growth of the child.” • Youth engage in age and developmentally appropriate social activities • Respect and protect youth’s rights DISCUSSION: How might this apply to sexual and reproductive wellness?

25. Ensuring Accessibility Plan ahead to secure appropriate accommodations for your discussion with youth who have disabilities • Regional services • School sexual wellness education staff • Public Health Nurse support • Usable version of the brochure • Folks with disabilities have as much interest in a healthy sex life as anyone else • They may have added vulnerabilities to plan around safety

26. Quiz

27. Break

28. Duties and Responsibilities Segment 3

29. ACTIVITY Scenarios

30. The Guide Get familiar with A Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention • Required and recommended duties • Tips for talking with youth • Case scenarios (and the answers to the questions) • Online resources

31. Case Worker Duties: Do Not Impose • Do not impose your judgements or biases on youth • Respect, professionalism, and self-management • Do not force or coerce youth • Do not refuse to address any issue based on your own feelings or beliefs • Be sensitive to trauma and cultural identity, which can greatly affect how youth view their own sexuality 31

32. Case Worker Duties: Access to Information You don’t have to be an expert! There are many ways to access information: • Foster Care Nurse • County public health department materials • Local health clinics such as Planned Parenthood • Reliable and unbiased online resources • School’s sexual health education provider • Conferences/training opportunities • Independent Living Program curriculum Opportunity to model how to safely search 32

33. Case Worker Duties: Medical Appointments Up-To-Date Appointments: • Ensure that the young person’s annual medical exam is happening once every 12 months • Check on other preventative medicine according to the American Academy of Pediatrics schedule Also: • Ensure access to gender affirming health care • Remind the youth that they can see the doctor of their choice within insurance 33

34. Case Worker Duties: Address Barriers Required: Ask youth if any barriers to accessing information or services exist. If so, make a timely plan. Best Practice: • If they identify no barriers, ask about • insurance information/medical card • appointment scheduling • transportation and other common barriers • Follow up with youth to ensure that the plan was enacted & successful • If not, make another plan until addressed 34

35. Caregiver Duties • Reasonable and prudent parenting standard—including appropriate romantic/sex life • Respect private storage and personal belongings • Facilitate access, including transportation • Notify the case worker of identified barriers • Ensure the young person receives medical exams according to the identified schedule 35

36. Case Plan Documentation Segment 4

37. Case Plan Documentation: New Mandates Annually required to document 1. Youth received Comprehensive Sex Education 2. Case worker informed/reviewed youth’s rights regarding sexual and reproductive health services 3. Access to services and information/removal of barriers when applicable

38. Case Plan Documentation: Sex Education At least once in middle school and at least once in high school, the youth or NMD (age 10+) 1. Has received comprehensive sexual health education as confirmed by school officials OR 2. How the county agency will ensure that the youth receives the instruction in the time frame • California Department of Education website • Statewide Roster of Grantees/Providers

39. CWS/CMS: Sex Education VIDEO 1: New functionality documenting sexual health education services for youth in foster care (7:41)

40. Case Plan Documentation: Informed of Rights Case worker has informed youth of or reviewed their right to: • Access information about sexual and reproductive health care services • Consent to those services • Confidentiality regarding those services This information is to be given in an age and developmentally appropriate way • At entry into care, • Upon placement change, and • Every six months after the most recent of those events

41. CWS/CMS: Informed of Rights VIDEO 2: New functionality documenting sexual and reproductive health rights (4:00)

42. Case Plan Documentation: Facilitated Access Workers record when they have facilitated access or removed a barrier to care Delivered Service contact in Contact Notebook Associated Services tab ‘Associated Service of Assist Access to Sexual/Repro Care Srvs’ Will populate Delivered Services Related to Sexual Health and Reproductive Care/Rights section of the Case Plan as pictured on next slide.

43. Sample Case Plan Document

44. Sensitive Health Information • Personal, detailed information does not belong in the case plan. In other documentation: • Avoid unnecessary details • Consider who may have access to the information—court, school, birth parents • Focus on protecting the young person’s privacy as possible This is their LIFE, not just their case.

45. Sensitive Information is Tricky • Outside of the case plan, documentation procedures can be less clear • Ask your county counsel and leadership about policies and procedures DISCUSSION: Can you remember a time when sensitive information was handled well or poorly and what you learned?

46. Break

47. Finding Resources, Safer Sex, and Contraception Methods Segment 5

48. Word Game ACTIVITY

49. Finding the Right Services • Promote safety and well-being • Youth-centered, trauma-informed, individualized care • Harm reduction when needed • Sexual and reproductive health is only part of an overall wellness plan • Offer options to empower youth to decide for themselves • Foster Care Nurse is great resource

50. Finding the Right Services • Keep in mind the specific individual and their unique needs • Consider transportation and convenience • Ask who the youth prefers to work with • Male or female doctor • Someone with special training • 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 topics, bring someone with them, etc.) • When searching for services, keep confidentiality in mind especially in smaller communities