Addressing Sexual Health Among Youth in Foster Care Group Homes: A Community-Engaged Grounded Theory Study

Abstract

US foster youth have elevated pregnancy and sexually transmitted infection (STI) rates, yet receive limited sexual health education and intervention. Thus, we sought to co-develop a comprehensive model of sexual health needs among youth in foster care group homes through a community-engaged research process with foster youth and foster care staff to inform such intervention. Our team conducted five in-depth focus groups with both foster youth placed in group homes and foster care staff (social workers and group home staff) in 2018–2019. We analyzed the data through iterative open, focus, axial, and selective/theoretical coding using constructivist grounded theory (GT) methods to produce a model of sexual health needs among youth in foster care group homes. GT analysis revealed the model’s core category, Addressing Sexual Health among Youth in Foster Care Group Homes, has three supporting categories: reproductive health system, relationship health, and mental health. The study model offers new pathways for comprehensively addressing sexual health and well-being in this specialized population, grounded in foster youth and staff members’ direct, lived experiences. This conceptualization expands current intervention options beyond pregnancy/STI education programs alone to a holistic, multilevel focus on the interrelated need for trauma-informed family planning and contraception care, mental health and substance use care, sexual and emotional safety, and healthy relationships.