Abstract
Introduction
The social environment of children in foster care is one of the factors that impact on their sexual and reproductive development. Understanding these aspects is essential for the development of effective prevention strategies informed by research. Our aim is to explore the primary concerns of caregivers regarding the sexual development of teenagers in foster care.
Methods
The participants, 24 teenage foster caregivers, aged 32 to 55 years, were recruited through a social service network collaborating with foster families.Three focus groups’ discussion was conducted with foster caregivers using a semi-structured interview between April and June 2023. A qualitative reflexive thematic analysis was employed, focusing on themes related to foster caregivers’ concerns and challenges regarding the sexual development of the foster teenagers. Researchers conducted line-by-line coding inductively using NVIVO 14 software.
Results
The findings revealed that caregivers are concerned about teenagers’ exposure to sexual risks, challenges in establishing healthy relationship boundaries, dominant behaviors, and early expressions of sexuality. However, certain inaccuracies in attribution and interpretation were identified, which may be attributed to a lack of knowledge and information about normative sexual development, attachment, resilience, and insufficient training as an affective-sexual educator. The participating foster caregivers often linked sexual behaviors and distorted thoughts of teenagers with past childhood experiences.
Conclusions
The gathered information contributes to a deeper understanding of the needs and deficiencies of this group.
Policy Implications
This data lays the groundwork for designing more targeted interventions tailored to the needs identified by caregivers, which demand an immediate response.
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Introduction
Adolescence constitutes a critical phase of development wherein the construction of sexual identity, exploration of intimacy, and decision-making regarding emotional relationships take on particular significance (Moreira et al., 2021). In this sense, the environment in which children grow up plays a significant role, as it determines whether their needs are satisfied. (Bradley, 2019). Experiences such as home instability and inadequate nutrition are examples of potentially stressful and physically perilous situation for the children. These situations have the potential to impede children’s capacity to cope effectively with the challenges presented in their environments (Avdibegović & Brkić, 2020).
Young people living in foster care not only face the common challenges associated with adolescence and early adulthood development, but they are also coping with additional issues that increase their vulnerability to health problems (Finigan-Carr et al., 2018). The foster care system addresses the need to provide a temporary and secure environment for children who cannot live with their families due to various reasons, such as abuse, neglect, or parental incapacity (Goicoechea et al., 2017). Therefore, foster caregivers play a crucial role in providing them with support and stability during their time in the foster care system. In this context, many foster children and teenagers face several potentially traumatic situations, as noted in some Spanish studies (Sabater-Pavía et al., 2012), including the separation from their biological family (Gil-Llario & Molero-Mañes, 2010) and the absence of a stable attachment figure (Jimeno, 2016).
According to studies carried out in Spain, teenagers in the child welfare system had experienced at least one type of victimization throughout their lives (Fernández-García et al., 2023; Segura et al., 2016). In fact, studies carried out in the United States of America also found that individuals who have been victims of childhood sexual abuse experienced significantly higher rates of revictimization of sexual assault, violence, and stalking (Indias et al., 2019; Katz et al., 2020; Papalia et al., 2021). The high rates of sexual victimization are associated with negative outcomes in behavioral, emotional, and cognitive development (Indias et al., 2019). The potential consequences of the victimization have been associated with engaging in unprotected sexual relations among sexually active teenagers (Cavanaugh, 2013).
Additionally, Ramseyer et al. (2016) suggest that adolescents who are in the welfare system might exhibit a greater inclination to participate in risky sexual behaviors and early sexual activities. This has also been observed in adolescents in foster care (Nuggent et al., 2020). There is also a higher prevalence of sexting and online sexual behaviors in youth in foster care compared to those who are not (Kobulsky et al., 2022).
Some teenagers may encounter greater difficulties in establishing trusting relationships with caregivers and meaningful connections with adults (Storer et al., 2014). This can have repercussions on how they engage in relationships with their partners (Scott et al., 2012), as teenagers often learn the model of romantic relationships from their caregivers and tend to reflect them (Brasileiro et al., 2023). Young people in foster care have described experiences such as the establishment of relationships with unequal power dynamics (Ahrens et al., 2016). Studies carried out in the United States of America also found that young people in foster care are at a higher risk of experiencing violence from their partners (Katz et al., 2020).
In this regard, foster caregivers play a crucial role in the sexual development of youth in foster care, as they can support them in navigating this process in the most appropriate manner (Brasileiro et al., 2022). However, foster caregivers encounter notable challenges when assuming the role of affective-sexual educators, as suggested by the findings of Nixon et al. (2019). Negotiating conflicts with adolescents in this context may diminish their ability to engage in open discussions about sexual health (Ahrens et al., 2023). The authors also underscore the importance of caregiver training as a crucial aspect to empower them in providing support to youth in foster care. The lack of specific studies addressing the sexual concerns of adolescents in foster care has created a gap in understanding their needs and challenges in this area (Grossi et al., 2016). Recognizing the difficulties and issues faced by caregivers in navigating the sexual development of adolescents/teenagers in foster care is imperative (Trejos-Castillo & Noriega, 2020). Therefore, the aim of the current study is to explore the main concerns of caregivers regarding the sexual development of adolescents in foster care.
Current Study
Caregivers play an essential role in providing support and guidance to children and adolescents in foster care, addressing not only their physical and emotional needs but also facilitating their sexual development. For this reason, it is crucial to pay attention to the specific concerns and challenges that caregivers encounter while guiding adolescents in this area. Understanding this is necessary for designing more effective support strategies for these foster youth (Brasileiro et al., 2022). To address this gap, we conducted a qualitative study inviting foster caregivers to share their concerns and challenges related to the sexual development of the adolescents under their care. This information will support the identification of areas of training about sexuality needed for caregivers.
This study was conducted in Spain. The data presented in this paper were collected as part of a broader study on the sexuality of youth in the welfare system.
Method
Study Design
Qualitative methods were employed to explore caregivers’ concerns about the developing sexuality of youth in foster care through focus group discussions.
Sampling and Recruitment of Participants
We used study aims to guide the selection of participants while adhering to inclusion criteria (Adler et al., 2019). Eligible participants included caregivers of youth in foster care aged between 15 and 19 years.
The recruitment for caregivers was primarily conducted through social service agencies collaborating with families in foster care. A researcher from the team informed these agencies about the study and requested that they disseminate the invitation to participate among foster caregivers. This sample was constructed to address a broader set of research questions than those presented in this article. Additionally, an aim was for the sample to encompass the diversity of caregivers involved in the foster care system.
Our convenience sample consisted of 24 caregivers of adolescents in foster care (22 were women and 2 were men). The age of caregivers ranged from 32 to 55 years. The study included foster caregivers with varying lengths of experience (between six months and twenty years): two had been caregivers for less than one year, seven had between one and five years of experience, eight had between five and ten years, and seven had been caregivers for over ten years.
Procedure
Data were collected between April and June 2023 from purposive samples of three focus group discussions.
A semi-structured interview guide was developed based on a literature review on youth sexuality and previous studies addressing the sexuality of this population conducted by our research team. The research team comprised experts in various fields: one in developmental psychology (MDGL), one in educational psychology (OFG), one in sexual health (VMM), and two psychologists (FOB and VEG). All authors have many years of experience in researching. The questions were of a semi-structured nature to explore key topics while allowing new areas of perspective to emerge. It is important to note that the interview guide was not designed to address the specific research questions of this article. The topics of the questions were linked to sexual health in general and more specifically to sexual assertiveness, risky sexual behaviors, the use of dating apps, and sexting. The findings presented in this work were unexpected and emerged inductively during the analysis process.
The interviews were conducted at a mutually agreed-upon location to ensure participants felt comfortable sharing their experiences by two members of the research team (MDGL and OFG). The duration of each focus group discussion ranged from 60 to 90 min.
All participants provided signed informed consent after being briefed on the characteristics related to anonymity, confidentiality, and the option to withdraw from the study at any time. With the participants’ consent, all interviews were audio-recorded. The study adhered to the ethical principles of the Declaration of Helsinki and was approved by the Experimental Research Ethics Committee of the University of Valencia.
Data Analysis
The focus group audio recordings were transcribed literally (assigning codes to each participant to ensure anonymity) by two researchers (VMM and OFG). A third member of the research team cross-checked the transcriptions with the recordings to verify their reliability (FOB).
Reflexive thematic analysis (Braun & Clarke, 2021) was employed to identify participants’ perceptions and concerns regarding the sexuality of teenagers in foster care. This method was considered the most appropriate, as our aim was not only to identify the themes related to their main concerns but also to comprehend caregivers’ experiences and thoughts regarding the sexuality of teenagers in foster care based on aspects that worried them. This requires the interpretation and generation of themes by the researcher (Braun & Clarke, 2023).
To ensure the rigor of the analysis, the six phases described by Braun and Clarke (2006) were followed. Firstly, two researchers (MDGL and VEG) extensively reviewed each transcript multiple times to gain a comprehensive understanding of the data’s depth and breadth, aiming to familiarize themselves with the data. This involved making marginal notes in the data book, identifying key terms, seeking additional meanings and patterns, and compiling detailed notes. Subsequently, these two researchers carried out the coding process, developing codes understood as significant information related to caregivers’ concerns. Two researchers (MDGL and VEG) conducted line-by-line coding for each transcript using NVIVO 14 qualitative analysis software. Once the coding framework was defined, the researchers applied the same codes to the entire dataset by labeling data excerpts and annotating potential connections between elements (Kiger & Varpio, 2020). Multiple reviews of the codes and their interrelation guided the generation of initial manifest and latent themes. To perform this task, the researchers reread the entire dataset to review the themes and recode additional data that were included in the themes. At this point, data excerpts were reorganized, and themes were modified to better capture the coded data. This first level of analysis concluded when the two researchers determined that the revised thematic map adequately covered all the data to be included in the subsequent analysis. Subjectivity is assumed due to the organization and decision-making process of the researchers during the result generation. Subsequently, the research team engaged in extensive reflective review and discussions on emerging themes. Each theme and subtheme were examined to ensure the identification of a coherent pattern (Nowell et al., 2017). In this way, new ideas were exchanged and incorporated into the findings (refinement). The reviews concluded when the researchers considered that all data elements were relevant to our research question and the themes were deemed coherent, and additional refinements would not produce substantial changes. This work facilitated the identification and designation of themes, as well as the selection of data citations to be presented in the paper (Braun & Clarke, 2012). Finally, the results were written to create a narrative for the data, continuing the analysis and interpretation initiated in the previous phases by these two researchers. Participant cites illustrating the themes were selected and bilingual speaker reviewed the translation.
Research Positionality and Reflexivity
According to Braun and Clarke (2006, 2021), it is essential that, during the results writing phase, a narrative is crafted to provide a clear and logical explanation of how the authors interpreted the collected information and the rationale behind the generation of themes. The writing of results is considered a continuation of the analysis and interpretation of data indicated in the previous phases. Therefore, it is important to avoid this section being merely a summary of the themes generated in the earlier analyses (Kiger & Varpio, 2020).
As the researchers overseeing the analysis hold expertise in psychology, particularly in the domains of children and adolescents, and include a professor specializing in education and developmental psychology, our study embraces a lifespan psychology perspective. In doing so, we recognize that adverse experiences during early ages can bring about changes at the neurological level, potentially influencing an individual's developmental trajectory. However, our perspective also acknowledges the inherent plasticity of the human brain. Consequently, experiences in later years may serve to mitigate the deficits that arose during childhood (Hochberg, 2011).
Thus, we consider development as a lifelong process, implying that changes can occur at any stage due to the multifaceted influence of biological, historical, cultural, and other normative or non-normative factors (Córdoba et al., 2008).
In other words, as the child achieves better social adjustment in childhood, they are likely to develop a higher level of empathy and sociability and a healthier relationship with their surroundings (Milicic, 2014). While the foundation of secure attachment takes root in early infancy, it is subject to modifications in subsequent years, albeit to a lesser extent (Bosmans et al., 2020; Walters et al., 2019; Van IJzendoorn & Juffer, 2006).
Additionally, around the age of 12, children undergo radical biological and psychological changes, along with sexual maturation, thereby contributing to an enhanced cognitive development.
However, within our perspective, we assume that individuals actively shape their developmental processes, exhibiting a dynamism not solely contingent upon their environment and not necessarily static over time. Previous studies have concluded that the influence of adolescents’ attachment style on socioemotional competencies can be mitigated through targeted training in emotional skills, thereby increasing life satisfaction and positive effect in adolescents (Mónaco et al., 2019; Zhang et al., 2016). In this context, resilience emerges as a salient concept referring to an individual’s capacity to confront adversity and overcome obstacles, encompassing conditions of physical, psychological, and social vulnerability (Suarez et al., 2004).
Moreover, we acknowledge that individuals construct reality based on their personal, historical, and cultural experiences. Consequently, we posit that statements arising during focus group discussions are influenced by individual experiences.
Results
Caregivers of adolescents in foster care expressed various concerns throughout the three focus groups. They shared anecdotes and, also exchanged views with the other group members on the two main themes that emerged: concerns related to the behaviors exhibited by the youth and the attributions and interpretations of the affective-sexual characteristics of the youth. Both categories are interconnected; caregivers, in expressing concerns about a subtopic, reflected the attributions they made to that behavior.
Are Experiences in Infancy Determinants of Development?
In terms of behaviors, a major concern emerged regarding the dominant conduct displayed by numerous young males in foster care toward their mothers. Caregivers interpret these dominant behaviors as indicative of sexist attitudes. Specifically, caregivers identify that young people hold benevolent sexist beliefs, rooted in the notion that men should be the protectors of women.
C9 reported that the youngest frequently remark: “Is that how you’re going to step out?” The same goes for the elder, both demonstrating a protective inclination towards women and asserting the belief that the man holds the reins at home. They do tend to display a sexist behavior, and that concerns me.
While participating caregivers seem to be aware of the risks associated with benevolent sexist attitudes, it is noteworthy that caregivers attribute such sexist behavior to the trauma resulting from both direct and indirect experiences that adolescents had in childhood. These experiences may include separation from the biological family, as well as instances of physical, sexual, and/or emotional victimization that young people may have encountered directly or witnessed. Furthermore, it appears that this interpretation of behavior and its categorization as 'sexist' is influenced by caregivers' knowledge of the experiences the young person underwent in childhood, as elucidated in the following quote:
C5: It’s incredibly, incredibly challenging. He goes crazy when he senses even the slightest approach from a man toward me. It’s possessiveness, a fear of losing me, or whatever it may be, but it surely stems from his entire history. The teenager spent about 2 and a half years with his biological mother, where he had complete control; by the age of 2, he decided what to eat, how to dress, and whatever he said was the rule. Then he came to live with us, where there were rules in this household, and he’s been with us for almost 8 years now. However, he doesn’t accept it. He tells me, “Well, at least you’ve stopped working, and you have to stay at home. Dad works, and you stay home with me.” Where am I not going? Because he felt the need to protect me at the age of 4 or 5. With his sister, it’s, “Don’t wear this outfit; Where is my sister going?”
Caregivers, furthermore, referred to the coping strategies that children develop in response to their early childhood experiences. Hereby especially control strategies, which are likely to start forming during early social relationships in childhood, were mentioned. Caregivers observe that, within the context of insecure attachment, the development of controlling strategies could serve as a means for managing resources, seeking survival, and/or attaining security.
P2: I believe the need to control is an attitude towards life, a survival mechanism, and he/she carries it with him/her. All the relationships he/she establishes are influenced by this personal need.
The lack of confidence and the need for control developed by children seem to pose some of the primary challenges encountered by foster caregivers. Nevertheless, it is noteworthy that such attributions may rather reflect the subjective perspectives of caregivers and an unconscious stigmatization associated with foster children.
How to Address the Challenge of Preventing Risky Sexual Behaviors?
Caregivers reported concerns about adolescents engaging in risky sexual relationship such as unprotected sexual intercourse. To emphasize the importance of this issue, they reported the negative consequences due to the sexual practices carried out by adolescents. Caregivers express concern about the lack of awareness, and the false beliefs derived from the information that young people have access to through social relationships, which may have serious consequences on the sexual health of teenagers.
P4: They have put themselves in dangerous situations… situations of tears because they are very dry. And I see that there is a lot of content on social media where there is no leading up to penetration. They believe that they already have information, but they don’t have, so...
Another major concern regarding risky sexual behaviors is associated with the use of social networks and contact apps. Caregivers have highlighted situations in which teenagers have been exposed through contact apps, including instances of contact with older individuals.
C10: We found out that she had signed up on a platform and was receiving messages from much older girls, significantly older, asking if she wanted to have relationships, messages of that nature.
It is also important to note that the transcription does not capture the tone and gestures that accompanied the statements. The non-verbal cues conveyed incredulity, indignation, helplessness, and a search for support from the other mothers, who nodded in agreement, indicating that they shared this concern. Thus, even though it was not explicitly stated that this was a concern, the message was clearly expressed and understood.
Sexual Development: What Are Normative Sexual Behaviors? What Are Not?
The caregivers also reported concerns regarding age-inappropriate sexual behaviors. These were situations that caregivers struggle to navigate due to the developmental stage. Generally, these behaviors were related to the search for pornographic material. Moreover, there were other situations caregivers have encountered that seemed challenging for them to understand.
C12: At 7 years old the curiosities would begin. He would start doing what he wanted and seeing what he wanted. We have no idea. So that’s a little bit, well you’re doing it... Well, that’s working and now at 12 it’s true that she has aroused a much more natural sexual interest. In the end, when his mother became a prostitute... his mother became a prostitute and then he must have heard things... we don’t know to what extent he has seen things. Then he even came with... he moaned from time, so he had that tone, something that you say... Could be? In addition, they also confirmed to us that he had seen porn on his cell phone. His mother would leave him the phone and the child with...
In response to this comment, another caregiver replied:
C3: He used to touch my foot, now I remember, and he had an erection when he was little.
If we compare both quotes, we can observe that, in the second quote, the primary caregiver is the one attributing a sexual interest to that involuntary response. The caregivers believe that this early interest in sexuality may be associated with the type of experiences the adolescents have had before entering the foster care system.
P1: I mentioned “distorted” because my experience, especially with younger children, but I also know colleagues who handle cases with teenagers who have been abused in their biological families. Often certain sexual behaviors have activated the alarm, indicating that something has happened. For this, the underlying problems have been exposed… So, teenagers aged 14-15 who experiencing abuse at 5, 6, 7 years old. Based on my experience, it has mostly involved children around 7-8 years old who may have experienced abuse in their early childhood. Those behaviors initially raised concerns, either with the foster parents or at school... and the alarms went off a bit.
Although the narrative of abuse is present in many discourses, some caregivers also emphasize that certain behaviors are associated with the behavioral modeling of children who spent enough time in their original families to remember specific experiences.
P3: Not only with children who have suffered child abuse but also with those who have witnessed inappropriate behavior by their parents. So, in terms of sexuality... some have expressed like, “Wow, I’ve seen them engage in sexual acts with the doors wide open without any limits.” They ask their foster family, “Don’t you?” I think, they normalize what is not appropriate. That’s why it’s also about what concept they have of sexuality…
The Need to Feel Loved Makes It Challenging to Establish Boundaries in Relationships
Foster youth caregivers express concerns about the distorted beliefs that young individuals harbor regarding gender roles and romantic relationships. They worry that teenagers may face difficulty in recognizing limits and accepting denials from others.
C4: If someone tells him no, that’s what worries me the most, from what I’ve seen in his relationship, for example, with girls he insists, insists. “They’re telling you no, stop insisting.”
The caregivers attribute this behavior to an inherent need in adolescents to feel loved and a fear of loneliness.
P1: It is that need to feel, well, that observed, desired. And to feel, well, that’s more than loved, well, that, that you’re the object of desire.
Given the challenges they face in identifying and socializing with their peer group, it appears that they rather seek to have a romantic partner.
S9: Neither of them has managed to form groups of friends, so they turn to the idea of having boyfriends or girlfriends because that comes more naturally to them. In that way, they have at least one person who is there for everything.
Furthermore, caregivers interpret that this need to feel loved is rooted in the idealization of a romantic partner and the belief that an individual is only considered valuable if someone loves them.
P3: When I talked to him, and if you notice, he is aware of this. -”What is it that prevents you from leaving?” And he took me, -”No one has loved me like this. She is the first person who has looked at me and loves me unconditionally... I must give in to everything she says because if I don’t, she will leave, and another person will leave my life again.”
These distortions regarding healthy relationship dynamics seem especially pronounced for those who have directly or indirectly experienced some form of violence in their biological families. Caregivers mentioned the normalization of partner violence, an aspect that needs to be addressed in the new family context.
P6: Because they come with an idea of what a romantic relationship is, based on what they have seen with their parents and how trustworthy the world is. So, when they observe the relationships of foster families, many of them ask questions like, “Do you guys fight?” I mean, they pose that question to the foster parents, “Do you guys fight?” Well, look, we argue because we love each other, we have disagreements and such. But they carry an idea in their minds, based on what they have learned about how a couple theoretically expresses2 love since they are married or together.
Discussion
The aim of this study was to explore the main concerns of caregivers of youth in foster care regarding the sexual development of these adolescents. Furthermore, the formulated research questions facilitated the identification of challenges faced by caregivers and the attributions they ascribe to the behavior of teenagers. This is crucial as it unveils areas requiring attention. Throughout our analysis, we have discerned that, in some instances, the attributions and interpretations made by caregivers are grounded in preconceived ideas that may be inadequate.
One of the recurring themes pertains to the concern about the dominant behaviors exhibited by the youth, which are interpreted as sexist and attributed to early childhood experiences (e.g., before the age of 2). The reported behaviors might be indicative of the attachment relationships formed by these teenagers with their foster caregivers. It is conceivable that caregivers, although with the best of intentions, may unintentionally apply an inappropriate parenting style due to the stigmatizing beliefs they hold toward these children (a phenomenon termed ‘double victimization,’ involving compassion for what the child may have experienced), resulting in teenagers adopting a dominant attitude. While children in foster care are often identified as having greater emotional disturbances (Mancinelli et al., 2021), these behaviors could also be viewed as attempts to control the caregiver—a mechanism that may be employed for survival, particularly in the face of resource deprivation situations (Schofield & Beek, 2005, 2018). Caregivers’ biases may stem from insufficient knowledge about attachment development. Such attributions pose a challenge to contributing to the resilience of adolescents.
In such cases, the risk of losing the caregiver could be perceived as the loss of a vital source of emotional, physical, psychological, and economic support (Hawley et al., 2009). Another important aspect prompts consideration of the “self-fulfilling prophecy” (Rosenthal & Jacobson, 1968), suggesting that individuals may conform to stereotypes and change their behavior to align with them. This phenomenon has been associated with an increase in problematic behaviors among foster youth (Day et al., 2022). While we acknowledge that caregiver parents should comprehend the impact of such events on the child’s health, they should also be informed about the role of their own behavior in modulating these effects (Vasileva & Petermann, 2018). In this regard, adopting a resilience perspective could enhance the overall coping strategies of the family, fostering a more attuned and appropriate dynamic between caregivers and foster children (Lietz et al., 2016). By focusing on the strengths of these young people, there are potential to increase their likelihood of perceiving themselves more positively and adjusting their behavior based on the positive qualities they possess.
As anticipated and consistent with the findings of Storer et al. (2014), foster caregivers express concern about the involvement of teenagers in risky sexual behaviors and activities. Youth in foster care encounter difficulties in trusting others and initiating discussions about sexual health (Ahrens et al., 2016). Moreover, caregivers also express a need for support to initiate these conversations and a demand for training on how to do so effectively (Brandon-Friedman & Swafford, 2023). Our results align with caregivers’ highlighting of this need, their apprehension about discussing sexual health, and their messages conveying the absence of a responsible figure for sexual education (Albertson et al., 2018; Harmon-Darrow et al., 2020). In many instances, we discerned that professionals’ involvement in the sexual health of adolescents becomes necessary once conflicts have already emerged (Steenbakkers et al., 2018). Caregivers also provided various examples of sexual behaviors exhibited by the youth when they were two years old, interpreting these behaviors as expressions of inappropriate early sexual interest. Such behaviors are attributed by caregivers to victimization and exposure to certain situations, such as being direct victims of sexual abuse, witnessing it, or exposure to sexual images at an early age. While recognizing that young individuals who have experienced abuse may exhibit a predisposition to certain inappropriate behaviors and attitudes (Fernández-García et al., 2023), some research suggests that the duration of exposure to maltreatment increases the likelihood of disrupting normative cognitive and behavioral development, rather than the type or severity of the abuse or violence (McGuire & Jackson, 2018).
Likewise, it is worth mentioning that the “warning signs” identified by caregivers often align with age-appropriate behaviors, and it is the caregivers who attribute a sexual interest to these behaviors, as illustrated the quote from one participant of the focus groups. This tendency displayed by non-family caregivers to attribute more behavioral problems has also been described previously (Shore et al., 2002). Participation in the foster care system is a social environment of health that should be considered when providing information on sexual and reproductive health to prevent additional problems that impact the well-being of young individuals (Finigan-Carr et al., 2018). However, despite recognizing the fundamental role that a foster caregiver can play as a promoter of sexual education (Serrano et al., 2018), there is a notable lack of training resources on this aspect.
Consistent with findings from previous literature, caregivers reported that teenagers engage in romantic relationships characterized by power imbalances and a lack of assertiveness (Ahrens et al., 2016). Participants in the here presented study believe that these romantic relationships hold significant meaning for these young individuals, generating the need to seek and initiate such relationships from early ages (Bay-Cheng & Fava, 2014). These results align with the findings of Ball et al. (2023), who found that adolescents quickly enter intimate relationships and maintain them due to the need for connection. In this regard, it is important to highlight the recommendations of Panisch et al. (2020), who propose that affective-sexual education programs for these young people should address specific aspects of their youths’ history within the protective system to enhance their skills in establishing healthy relationships (Fava & Bay-Cheng, 2013).
It is noteworthy that the educators in this study reported a series of feelings similar to those described in other research, such as concern, insecurity, fear, and powerlessness (Sivis-Cetinkaya, 2015). Throughout the focus groups, many participants expressed gratitude for the opportunity to share their experiences, as has also been observed in other studies (Melkman, 2024).
It is important to frame the perceptions of foster caregivers in the context of Spanish culture, as our participants’ perceptions may be influenced by various factors. Foster caregivers in Spain, similar to those in other countries, often experience discomfort when discussing sexual topics with adolescents. However, this discomfort is likely exacerbated by the expectations and regulations within the Child Welfare System. Given that foster caregivers in the Child Welfare System are supervised by child protection workers, there is additional pressure on their behavior and parenting style. Although some of their perceptions may align with those of parents of adolescents generally, foster caregivers face unique challenges and increased scrutiny. Their perceptions are shaped by the need to adhere to specific guidelines and ensure the safety and well-being of the children under their care, making their experiences distinct within the child protection framework.
Social-Policy Implications
In light of our findings, it is crucial to emphasize the importance of equipping foster caregivers with effective tools to address the challenges they encounter. Ahrens et al. (2023) highlighted that caregiver training could be essential to improve their capacity to provide support to youth in foster care. Therefore, understanding the difficulties that foster caregivers face regarding the sexual development of foster youth is pivotal for designing effective support strategies (Trejos-Castillo & Noriega, 2020). Our results align with the topics on which caregivers of young people in foster care wish to receive more information on topics, such as peer pressure, establishing and maintaining friendships, sexual health, puberty, and the use of technology (Brasileiro et al., 2022). However, based on our findings, we assert that caregivers also need training in areas of which they may not be aware. Therefore, we recommend that, in the training of foster caregivers, in addition to the afore mentioned topics, emphasis be placed on emotional and sexual development in childhood and adolescence. This approach aims to demystify and destigmatize foster children. Furthermore, it is necessary to provide support and training to foster caregivers to facilitate discussions about sexuality with these young individuals and to build trusting relationships (Serrano et al., 2018). This way, caregivers can play a more active and effective role in fostering resilience in foster children. In certain groups, joint training for caregivers and children has already been implemented (Corona et al., 2016; Pugliese et al., 2020). Perhaps, it is time to reflect on this approach in other populations.
Limitations and Future Research Directions
It is worth noting that our study is not exempt from limitations. Given the sample size, definitive generalizations cannot be made solely based on this research. Additionally, the majority of our sample consists of female caregivers. The limited number of male fathers is a constraint, but unfortunately, the absence of male caregivers in Spain’s Child Welfare system is a common occurrence, and their participation is not always easy to secure. Thus, replicating this study would be beneficial to strengthen the validity of the results obtained.
Conclusion
In conclusion, the narratives provided by caregivers of minors in foster care not only enrich our understanding of the sexual dynamics of these young individuals but also highlight the need to develop policies and practices tailored to the identified needs. Despite foster caregivers in Spain receiving training in this area, it is evident that they lack essential and necessary information for the care of children. Many of the experiences described by our participants could not have been captured without resorting to qualitative research. This study has provided us with the opportunity to gain deeper insights into the experiences of being a caregiver in relation to a topic that remains sensitive in society, enabling caregivers to openly share their concerns about it.
Data Availability
The data are not publicly available due to privacy or ethical restrictions. Research data are not shared.
Code Availability
Not applicable.
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Gil-Llario, M.D., Estruch-García, V., Ortas-Barajas, F. et al. A Qualitative Analysis About Sexual Health of Foster Teenagers: What Concerns Do Their Caregivers Have?. Sex Res Soc Policy (2024). https://doi.org/10.1007/s13178-024-00995-4
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DOI: https://doi.org/10.1007/s13178-024-00995-4