A foster carer’s introduction to sexual health for children and young people in care
Introduction to sexual health for children and young people in care
As foster carers it’s vital to have open discussions with the children about their health, and this should include sexual health. Children in care often experience trauma due to various factors, such as neglect, abuse, or separation from their families. This trauma can have lasting effects on their overall health, including sexual health. Traumatic experiences may lead to emotional and psychological challenges, affecting their self-esteem, trust in others, and ability to form healthy relationships.
These difficulties can influence how they approach intimacy, make decisions related to sexual activity, and cope with the complex emotions associated with their experiences. It is essential for foster carers and professionals to provide a supportive and understanding environment to help these children heal and develop positive attitudes towards their sexual health and wellbeing.
We need to create a safe and supportive culture as it is essential in addressing sensitive topics for children in care.
Your role as a foster carer
As a foster carer we work as part of a team, we also never have parental responsibly (PR), so understanding our role is crucial.
When it comes to sexual health it is imperative to ensure you have discussions with the child or young person’s social worker, and your own. They make the decisions or give (written) permissions for any actions to be taken.
As hard as it might be, you are not in a position to ‘keep secrets’ or keep disclosures made by a child or young person confidential. This can be easily discussed with them by telling them right from the start that you may disclose certain things to their social worker when they are deemed at risk of harm, but assure them this is absolutely about keeping them safe and caring for them and having their best interests at heart.
As always our role as foster carers is underpinned by National Minimum Standards and Statutory regulations.
When it comes to sexual health our obligations would fall under the following NMS and TSDS (Training, Support and Development Standards)
Fostering Services National Minimum Standards (England) 2011:
- Standard 1 – The child’s wishes and feelings and those significant to them.
- Standard 6 – Promoting Health and Wellbeing.
- Standard 8 – Promoting Educational Attainment.
Training, Support and Development Standards for Foster Care:
- Standard 2 – Understand your role as a foster carer.
- Standard 3 – Understand health and safety, and healthy care.
- Standard 5 – Understand the development of children and young people.
Puberty can be a challenging enough time for a young person, but when you add being in care to that it can be very difficult to navigate.
Puberty can be embarrassing for children in care due to the lack of a strong support system, unfamiliar environments, movement from one family to an other, and past traumatic experiences.
These factors can intensify feelings of confusion, self-consciousness, and insecurity about their changing bodies.
It is therefore crucial to offer understanding, compassion, and open communication to help them navigate this sensitive phase and feel more comfortable during this transformative period of their lives.
How can foster cares help?
Children and young people may have had limited access to sexual health and relationships (SHR) education, this can make them more vulnerable, and it can happen because of barriers like school absence, frequent moves, and poor relationships.
So foster carers can be pivotal to providing understanding and guidance and discussing that it is a normal and natural process, and help adolescents embrace the changes and navigate this transformative phase with confidence.
What are the aspects of sexual health to discuss
- The importance of healthy relationships.
- Sexual orientation.
- Sexually transmitted infections (STIs).
- Responsible decision making.
Empower teenagers with knowledge of various aspects of sexual health.
- Appropriate and inappropriate behaviour.
- How to treat others with respect.
- How to avoid harm.
- Child pornography.
- Empowering conversations about healthy relationships.
- Staying safe online.
- It’s ok to say no.
- Tell a trusted adult.
- Consent – We need to start talking early to children about mutuality and consent; openly discuss grooming including online, exploitation, and control and coercion in relationships; gender dynamics and LGBTI issues. When children learn about sharing and asking for permission, they understand boundaries. As they grow older, we can discuss respecting others and agreeing together.
Useful page for understanding adolescence in care: https://fosterwiki.com/wiki/teenagers-a-guide-to-fostering-adolescents/
Talking about it
Establishing trust with children takes time, especially if they have been let down by adults before. However, once trust is gained, they are more likely to feel comfortable sharing their feelings and experiences. Building a safe and supportive environment can encourage open communication and emotional connection with children.
This involves an understanding of trauma informed care, the adverse childhood experiences and attachment issues that will be driving a young person’s relationships and sexual behaviours.
How to talk about it
It takes time to create an environment that children and young people can feel safe and secure in.
With our looked after children you have to take into account the trauma and low self esteem, something that will often lead to a need to be liked, loved, approved of and a strong need to belong, this can make relationships difficult to navigate and often our young people can mistake overt sexual advances and romantic overtures as approval, as love, approval or belonging.
- From the offset let children and young people know it’s okay to talk about health and sexual health.
- Look for opportunities to open up conversations about sexual health naturally, addressing it head on and not as part of a natural conversation might shut a young person down.
- Use open questions to encourage them to share their thoughts.
- Pay attention and show you care about what they say, be empathic and listen.
- Never dismiss their feelings, we all remember how strong and real those ‘first loves’ can feel.
- Let them know you’re there to help with any questions.
- Let them know if they have a situation or are in trouble you are unconditionally there to support and help them, will not judge and work it through with them, that way it’s more likely they come to you if something feels wrong.
- Be mindful that conversations and discussions about sexual health and relationships can be more complex if the child or young person have been abused. You will need to work closely with the team around and other professionals to help them understand about sexual health, relationships and sexual behaviour, and help them to develop trusting appropriate relationships.
Some tips for those conversations
There is a statutory requirement that a child has a health assessment with a looked after nurse. The foster carer and the child should be given a copy of their health plan. This will record what was discussed.
Depending on the legal status of the child and their circumstances, the child’s parents may attend these appointments.
The looked after nurse can reassure the child or teen that they are there to help and advise if you have any concerns about the child’s health in terms of sexual health, contraception, smoking, drugs and alcohol, referral to CAMHS, referral to speech and language, any other.
The health plans of children should clearly outline: their sexual health needs; what information/intervention is required; and which individuals/agencies will be involved in meeting needs and how This is particularly important for a child at risk of sexual exploitation or demonstrating problematic sexual behaviours.
Foster carers experience
We like to give you real examples from foster carers to see how it works in practice:
“During a conversation with A she mentioned she was in a relationship, and from what I understood she was having sex with the young man, she is 17. We talked about contraception and about possible pregnancy and she then said she wanted to explore birth control options. I consulted with A’s social worker and the looked after nurse to seek their advice.
Her social worker and her team manager consulted A’s parent, as they have parental responsibility for medical decisions. With her parent’s consent, we arranged a visit to a healthcare provider to discuss suitable birth control methods for A. The healthcare professional provided information about various options, empowering A to make an informed decision that respected their preferences and health needs. Throughout the process, we followed all the protocol and instruction from the local authority to ensure A’s wellbeing.
A and I then chatted on the way home in the car, I often find car journeys better for these kinds of chats as there’s no direct eye contact, there’s usually music in the background and it feels easier and more natural. She was thinking about the Pill or an implant, she then joked about her memory and needing to improve her organisational skills, and decided the implant would be much easier for her. After all the appropriate permissions we went back to the health centre and the implant was fitted.”
Summing up conversations
- Be in a calm place and natural space.
- Use the right language for their age, and remember to work with their emotional age not their actual age.
- Be empathic and supportive, listen without judgment.
- Answer questions as honestly and openly as you can.
- Respect boundaries and be aware of the pace of the conversation, let the young person lead and dictate the speed and direction.
- Ensure you have helpful and factual resources.
- Make sure they know you are available to talk anytime.
Some foster carers may choose not to discuss sexual health with adolescents due to perceptions that there are others who are better qualified to undertake this role, but usually it can help if the foster carers have formed a trusting bond with a young person. If you feel uncomfortable about it you can ask your supervising social worker for help, support and training on the subject.
SEN, disabilities, learning difficulties, or autism.
The discussions with children around staying safe and looking after sexual health is incredibly challenging when supporting a child with SEN, disabilities, learning difficulties, or autism. It might feel scary or overwhelming at times for the child, but with patience from you , and lots of understanding, with the right resources and support, including training, we can create a supportive and accessible environment to help them navigate these important topics.
Foster carers experience
T is a 15 year-old autistic young man with the understanding of an 8-year-old, I noticed he is struggling with the emotional aspects of his relationship with his girlfriend, who also has a disability.
To support him, I engage in open conversations, use social stories and visual aids to help him understand emotions better. We work together on coping strategies for managing overwhelming feelings. I also discussed with the social worker and the looked after nurse to ensure we provide him with the right emotional support and therapy to address his trauma and emotional needs effectively.
Many children and young people are subjected to a myriad of sexual information via the internet from a younger and younger age, so it’s important to help them navigate this.
Work with your young people and get help from the other professionals in the team to educate them on the vast amount of material they will encounter and be subject to on the internet.
Culture and heritage
Your child’s Placement Plan should be clear of any family religious beliefs or family values that underpin sexual health and education. If a parent expresses wishes about their child’s sexual health or education this must be taken into account.
However the first consideration is always to safeguard a young person’s health and well-being, so if you are concerned about any aspect of this speak to your supervising social worker and the child’s social worker.
When talking about sexual health, we need to be sensitive, caring, and inclusive to all children. We must think about our focus on positive values like consent and healthy relationships.
Culture significantly influences attitudes and practices related to sexual health, impacting how individuals approach relationships, consent, contraception, and STIs.
- Ensure you have training on Sexual health and culture.
- Topics such as genital mutilation (FGM), male circumcision, religion.
- Understand there are different attitudes to sex among young people of different ethnic backgrounds, how much they socialise with other groups, the role of religion in their lives, the attitude and beliefs of their parents, how gender differences vary in different ethnic groups.
The desire for someone that ‘loves them’
Young people in care can often express the desire for a child of their own, to create their ‘own family’ one that will love them and help them with the feelings of loss, belonging, instability and love.
“G came to us when she was just 13yrs, she had already spent half her life caring for her 2 younger siblings, she was in a fostering family with them until it broke down and she was moved, we were about her 4th fostering family in a very short space of time. She came from a family of 8 all of whom were, or had been in care.
We asked G what she would like us to help her with and what she would like out of life, without hesitation she said ‘I want a baby of my own who will love me, as soon as I can.’ I knew we had our work cut out to try and help her not to get pregnant as she was already engaging in sexual activity by then.
Conversations around contraception and sexual activity went from neigh on impossible to vaguely sensible and sometimes down right hilarious, that’s the reality of it, She was however badly missing her siblings and contact had not been forthcoming, she not just missed them but really worried about them as she felt responsible for them and was the one who ‘always looked after them’. Seen as a ‘trouble maker’ and a ‘bad influence’ she had been kept from her brother and sister.
We set about creating the conditions for family time with D and K and made it happen. Once regular contact resumed she was a little happier, and we get her reengaged in education, she found some good friends and got some GCSE’s and went to college.
She wanted to go into independent accommodation and connect back with family at 17yrs, and after a tricky time we managed to get her a great living space and she settled down.
She met her partner at just 18yrs and by 19yrs had her first baby, she now has 3 and is settled in a lovely house with her partner.
Goodness knows how we got her to 19yrs without a pregnancy, I will not pretend we were amazing carers and fantastic as the whole sexual guidance thing, it was a bit of a hope and a prayer, help from loads of professionals around us, keeping on it, trying to help and guide without judgment and lots of trauma informed care.
Still I’m proud to say we are now ‘Nan and Grandad’ to her little ones and there is not a social worker in sight, with the eldest doing well at school and she is now studying online to become a youth counsellor.
This is not at all unusual as many looked after children have a strong desire to have a baby of their own, existentially it is about creating their own family and replacing the love and attachment they never had.
It is a primeval need so they don’t really take into account the practical implications of how they could support a baby, and how they are unlikely to be emotionally prepared or financially able.
These are discussions you, as a foster carer can gently have with them.”
- Advice on contraception must be from the appropriate sexual health services who are trained to do this.
- Some children under the age of 16yrs in care are sexually active, however only a parent of guardian can give permission and consent for any discussions and advice on contraception.
- If you are concerned that any child 13yrs or under has engaged in sexual activity you must report it to your social work team who will then refer it to the local authority’s Safeguarding board/child protection referral.
- Remember that young people have a right to know what to expect regarding confidentiality and right to privacy. It’s very important you let them understand the limitations in your role of keeping safeguarding issues confidential.
- If you think a child or young person is being exploited, abused or at risk of significant harm you can help them report it, but if they don’t you have an obligation to report it to your supervising social worker and child’s social worker who will then share it with the Local Safeguarding Board and Child Protection.
- Access training for yourselves and your young people (where appropriate) on grooming and sexual exploitation.
- Harmful sexual behaviour (HSB) is a term used to describe sexual actions that are outside what is safe for a young person’s stage of development. It includes actions that can harm either the child or young person themselves, or another person. This is particularly important for a child at risk of sexual exploitation or demonstrating problematic sexual behaviours.
Reporting and Recording
It is so important to record significant conversations and report any concerns you have to your supervising social worker and the child or young person’s social worker.
Speak to social workers should you have a child protection, don’t just record it, flag it up. Always make sure you write up your records on the day as it’s sometimes hard to remember everything at a later date. Your records are important for care plans and for accessing help and support for the young person, and to protect own role as a foster carer.
Your supervising social worker should be able to give you clear guidance on how to record sexual health discussions and to identify any training that would be helpful.
Help and support created for foster carers, by foster carers, we are the experts by experience. We have the first foster carers knowledge bank. Access both the open pages and members area. Both are free to access and footprint-free. The member’s area gives you privileged confidential access to FosterWiki’s experts by experience for advice and guidance. You will also find short courses and guides from the foster carer’s perspective, top tips, allegation help, templates, and the ability to add to FosterWiki. With more content being uploaded regularly. Please let us know what information or advice pages you would find useful and we will put them in place. https://fosterwiki.com/register/
Information, Help and Support
Help and support created for foster carers, by foster carers, we are the experts by experience. We have the first foster carers knowledge bank.
Access both the open pages and members area. Both are free to access and footprint-free. The member’s area gives you privileged confidential access to FosterWiki’s experts by experience for advice and guidance. You will also find short courses and guides from the foster carer’s perspective, top tips, allegation help, templates, and the ability to add to FosterWiki. With more content being uploaded regularly.
Please let us know what information or advice pages you would find useful and we will put them in place. https://fosterwiki.com/register/