Welcome to the TFYHI FAQs for Caregivers! In this section you’ll find Frequently Asked Questions and applicable strategies to use when talking with youth in care about their sexual health and relationships. Looking to join an ongoing conversation about these topics and more? Join our caregiver online community!
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As a foster parent or caregiver, you play a vital role in supporting the well-being of youth in your care. This includes supporting their sexual and reproductive health and healthy relationships. For all youth, including youth in foster care, engaging in ongoing conversations about sexuality and relationships with trusted adults can increase resilience and support healthy development.
There are no rules that limit your ability to talk with youth in your care to support their sexual and relational health. In fact, Minimum Standards for Child Placing Agencies (749.1309) indicates service plans for youth ages 13 and up should address the topic of sexual health.
Although it can be uncomfortable, you can and should have conversations with your foster child about these topics. Read through the FAQs below for information and ideas to support you in having these conversations. To connect with other foster caregivers navigating these topics, visit our caregiver Facebook group. You can also learn more about Brave Conversations, our training for caregivers.
It can feel awkward or difficult to start conversations about sex and relationships with young people in your care. But when you engage with youth in brave conversations about challenging topics, you model healthy relationships and build young people’s communication skills.
There are many ways you can start a conversation. Some suggestions are below. Remember, these are not intended to be used as a “script”—the most important thing is that the conversation feels supportive, nonjudgmental, and authentic to you and your relationship with your foster child.
Use Teachable Moments: There are touchpoints all around us that can be used for discussions. Books, movies, music, and social media all provide great conversation starters for discussing sexual health and helping youth connect their experiences to what others might have experienced. For example, if you are watching a TV show that portrays an abusive relationship, you could ask your child what they think about that couple, or who their favorite couple on the show is and why.
Fill Out a Collaborative Contract: At the beginning of a placement, or when an issue becomes relevant to a young person’s life, you can use a contract to discuss together what rules are nonnegotiable and which ones you can decide on collaboratively with your young person.
Use a Resource: For ideas about ways to start a conversation about specific topics, check out the Kids-Ask website.
Many people are uncomfortable discussing sex and relationships, particularly with youth in their care. In addition to social stigmas, personal values or experiences can make these topics difficult to discuss. If you are feeling uncomfortable, it can be helpful for you to name that in conversation. It is also always okay to let a young person know that you don’t know the answer to a question and need to return to a conversation at another time after you’ve had a chance to get more information.
Adults’ past negative or traumatic experiences can also be brought up during these conversations. If this happens, adults can check in with themselves to understand their own reactions to sensitive topics and take steps to care for themselves while also providing a safe, supportive space for youth. The National Domestic Violence Hotline (800-799-7233) and National Sexual Assault Hotline (800-656-4673) are resources available 24/7 for both youth and adults.
We all have different experiences, backgrounds, and values around many topics, including sex and relationships. While you can set boundaries and rules for youth in your care, you cannot impose your values on them, particularly when it comes to youth rights.
It can also be helpful to remember that what you experienced growing up is not necessarily the reality of the youth in your care; they are the expert on their own life, circumstances, and needs. Additionally, avoid criticizing a young person’s family, even if your values differ from theirs.
One strategy to discuss values-based topics with your foster child is S.O.Y (Some, Others, You). For example, if your child asks whether it’s okay to masturbate, you can respond:
“That’s a good question!”
Some people think it’s never okay to masturbate.
Other people think it is okay to do in private.
What do You believe? I always want to know what you think about important things like this.”
There are many online resources that you and youth in your care can use to access trustworthy, medically accurate information. Our Brave Conversations training comes with handouts and worksheets guiding you through discussions about healthy relationships, healthcare visits, and more.
Another resource you can use is the OkaySo app. Through OkaySo, youth and adults can ask questions anonymously and receive answers from sexual health experts. To connect with an expert who is part of TFYHI and understands unique considerations for youth in care and foster families, select Healthy Futures of Texas or Talk About it Dallas: Powered by Ntarupt as your expert group when you ask a question in the app.
Identifying other trusted adults—such as family members, mentors, coaches, or teachers—who can talk to young people can be very helpful. In particular, look for mentors who have survived trauma or experienced foster care themselves. Their unique insight may help them connect with and support youth.
Another resource to share with youth in your care is the OkaySo app. Through OkaySo, youth and adults can ask questions anonymously and receive answers from sexual health experts. To connect with an expert who is part of TFYHI and understands unique considerations for youth in care and foster families, select Healthy Futures of Texas or Talk About it Dallas: Powered by Ntarupt as your expert group when you ask a question in the app.
When discussing healthy relationships with young people, you should talk about how to set boundaries, treat others with respect, and build a relationship based in equality.
Youth also need to know that they deserve a healthy relationship in which they are valued, and their boundaries are respected. By modeling these things in your communication with your child, you can help lay the foundation for them
to recognize respect and healthy boundaries in their dating relationships and friendships. For more information and resources you can share with youth, visit the love is respect website.
Signs that a relationship may be unhealthy include a power imbalance, isolation, invasions of privacy, and possessiveness or jealousy. To learn more about warning signs in a relationship, visit the love is respect website.
If you are concerned about your child’s relationship, it is important to maintain communication with them and let them know you are a safe person to talk to. One way to start a conversation with a young person about their relationship is to share the Is Your Relationship Healthy? quiz with them. The National Domestic Violence Hotline (800-799-7233) and National Sexual Assault Hotline (800-656-4673) are resources available 24/7 for both youth and adults.
Young people may experience trauma when adverse, stressful events occur. This can include both single, acute events (such as an accidental house fire) and recurrent events such as family violence. Learn more about childhood trauma from Changing Minds, a national campaign addressing children’s exposure to violence.
Although childhood trauma can cause lifelong harm, children can develop resilience to adverse events and caregivers can help protect children from the impact of trauma. Learn more about resilience from Harvard’s Center on the Developing Child.
If we want to better understand some of the challenges that youth in foster care experience, we need to understand the impact of trauma on social-emotional development, relationships, and sexual behavior. Effects can include:
- Power struggles
It is important to recognize both the potential impacts of trauma and your foster child’s ability to heal and create healthy relationships with support. You do not need to know the details of a child’s trauma history in order to create a supportive, trauma-informed environment and relationship. One of the most important aspects of a trauma-informed conversation is to avoid messages that reinforce fear or shame.
All youth should have a safe and supportive space where they can be themselves and express their gender and sexual identities. You can help create safe spaces for the youth in your life by:
- Not making assumptions about a young person’s gender or sexual identity
- Using inclusive language like “partner” instead of gendered language like “boyfriend”
- Thinking outside the gender binary and respecting diverse gender and sexual expression
Find additional information about supporting LGBTQ+ youth in care with this factsheet from the Children’s Bureau.
Although federal law DOES protect confidential access to family planning services, there are some requirements around medication storage and documentation that make complete privacy challenging for youth in care.
Specifically, Minimum Standards requires that all medications in foster homes and residential facilities be kept locked up. Additionally, medication logs must be kept documenting each time a medication is taken. This presents challenges to maintaining total privacy for youth. It’s important to follow all the laws and regulations. It is also important to respect a youth’s privacy and right to make decisions about their own medical care.
Yes. Youth do not need adult consent to acquire non-prescription contraceptives like condoms, spermicides, and emergency contraception like the morning-after pill. Additionally, youth do not need consent from an adult to obtain contraception if they visit a Medicaid/ STAR Health provider or a Title X Clinic.
Youth also have the right to say no to being placed on contraception.
A youth in care may request contraceptive services through their healthcare team or other family planning services provider. The decision to provide a minor with contraception and to obtain the appropriate consent, if applicable, is the healthcare provider‘s responsibility. This means it is not the caregiver’s nor the caseworker’s responsibility to obtain consent. Additionally, the DFPS caseworker must not attempt to prohibit the youth from seeking contraceptive services. For more information, please review the DFPS Medical Services Resource Guide and DFPS Handbook.
Youth in DFPS conservatorship can obtain contraceptive services through Medicaid-approved programs and Title X Clinics. Find a Title IX clinic near you.
Youth, CPS staff, and caregivers may access the following resources to learn more about contraceptive options:
- The youth’s healthcare provider during the Texas Health Steps Medical Checkups or gynecological examinations.
- The Texas Department of State Health Services or other community family-planning clinics that offer sex education, counseling, and birth control assistance to Medicaid recipients and income-eligible clients.
Youth have several options for accessing STI testing and treatment:
- Screening for STIs: Screening for some STIs is covered in the Texas Health Steps periodicity schedule.
- Testing and Treatment: Youth can access testing and treatment through their STAR Medicaid provider or through a Title X Clinic.
- Affordable Options: Youth in care have access to Medicaid or STAR Health, which entitles them to full coverage for most sexual and reproductive health services. We encourage youth to ask their provider before receiving any services.
- For any coverage questions, youth may reach out to STAR Health Member Services at 1-866-912-6283.
If a youth in DFPS conservatorship informs a caseworker that they are or believe they may be pregnant, or the caseworker otherwise becomes aware of the youth’s pregnancy or possible pregnancy, the caseworker must ensure that the youth has an appointment with a STAR Health provider as soon as possible. For more information, review So You’re Pregnant, Now What? from Texas Health and Human Services.
A youth who chooses to have an abortion must either obtain their parent’s consent or seek a judicial bypass (a court order allowing the youth to have an abortion without receiving consent from or telling their parents or legal guardian). The caseworker and medical consenter must not approve or authorize an abortion or sign abortion-related medical consent forms or assist the youth in applying for a judicial bypass. Medical consenters cannot consent to abortion. Neither medical consenters nor CPS staff can assist the youth in applying for judicial bypass for approval for abortion.