HIGH STAKES, SILENT SYSTEMS: For part three of The Imprint’s series on sexual and reproductive rights in foster care, an experienced sexual health educator speaks about how caseworkers and caregivers can support youth through the most sensitive stages of adolescence. Read part one of the series here and part two here.
Theo Isoz, a sexual health educator for the Colorado Department of Human Services, spoke to the Imprint about how communication with foster youth must include topics beyond how to prevent pregnancy and sexually transmitted infections, and address the importance of consent and cultivating healthy relationships and boundaries.
A recent Imprint investigation published May 9 revealed that dozens of states lack formal or detailed policy guidance to support foster youth with the information they need as they go through puberty. A search of tens of thousands of pages of manuals revealed little or no mention of healthy relationships and sex ed, or the rights of foster youth to access contraception and abortion.
In some states, policies have lay dormant for decades. In others, rules governing the lives of foster youth at times clash with reproductive health care rights available to all minors, The Imprint found.
The federal government has taken some steps to assist, providing hundreds of millions of dollars over the past decade that can be used to educate young people in state custody. The Colorado Sexual Health Initiative is one such effort. Launched in 2011, the program now provides foster youth and their caregivers with age-appropriate, medically accurate sexual health education.
Isoz, who uses the pronoun they, helps lead that work, shaping curriculums for young people in foster care and the justice system. They began their career as a high school math and physics teacher before transitioning into sex education in Colorado public schools and, three years ago, joining the state’s Department of Human Services.
The Colorado Sexual Health Initiative (casually called CoSHI – pronounced “Co-Shy” – by its supporters) provides programming for system-involved youth, training for child welfare and other youth-serving professionals and foster parents, and funds organizations that provide sex education to the youth in their care.
“We all have to own that this is uncomfortable,” an audience member commented at a recent virtual town hall hosted by Isoz and their CoSHI colleagues. “Yet I do welcome certain people to have that conversation with my children. There is that gray area, and we have to be thoughtful about it.”
In a survey of attendees, 92% said they weren’t aware of their home counties having any policy regarding the provision of sexual health education or similar services for “system impacted youth.”
“Schools can’t do it alone, none of us can do sex education alone. Whenever we’re talking about sexual health, we’re not telling young people what to believe,” said Isoz to the online audience. “We’re talking to them about the facts, and we’re talking to them about the skills of decision-making. Then we’re saying what does your family — and your community, and your religion and your culture — believe on these topics?”
In a recent Zoom interview, Isoz described their experience working with young people, and shared advice for parents and professional caregivers. They also described an urgent need for clarity on the rights of foster youth to access sexual and reproductive health care.
The following has been lightly edited for length and clarity.
What are the biggest misconceptions you hear on sexual and reproductive health from caregivers and professionals in the youth justice or foster care system? What’s the one issue you wish you could get everybody in a room and set them straight on?
The lack of talking about it is a huge misconception. You’re already talking about these issues, you just don’t realize it. The strict guidelines or rules that you’re putting around sexual activity — or the lack of talking about it — are already sending a message.
For example, when we’re thinking of young people who are incarcerated, there are rules like “you’re not allowed to be sexually active.” Therefore, they won’t talk about sex. But that doesn’t support youth after they are not incarcerated.
In some foster care situations, it’s like, “well, while you’re in this particular home, you’re not allowed to have sex.” So therefore, we don’t really need to talk about it, because it’s not a thing that you’re going to be doing, right?
I also think there’s a misconception that sexual health has to be vulgar or intensely graphic.
You’ve suggested these conversations aren’t just about having sex and pregnancy — how are healthy relationship conversations more than that?
So much of what young people actually are needing is people talking about: “How are you connecting with people? What is feeling good and supportive and loving, and what is feeling coercive and manipulative in your life?” We tend to just think of something that’s much more mechanical and just specifically sex, and we’re missing out on all of those other conversations that are deeply affecting people as well.
We also think about young people needing sex education, for example, as some sort of intervention. We often try to punt it off, like, they need a class. And the class is helpful, but it’s the people that they connect to through that, more than having the perfect information. It’s actually the trusted adult relationships — that is the intervention.
Your relationship to the young person will make all the difference in their sexual health future.
Why else is it important for foster youth to have these conversations?
It’s relationships, healthy relationships, and it’s consent — and specifically the nuances of healthy relationships and consent. That’s one of my biggest, most important messages about sexuality and sexual health that we try to convey.
It’s not pregnancy prevention per se. It’s not just about condoms or any of those things. It is that you have agency over your body. The deeper you are in systems, the less agency you have over your body, over who touches your body, over how your body is touched, over where you are, over how you dress, over how you are allowed to speak, over so many things.
It becomes really deeply important that we affirm that: No, actually, you have choice over your body and over yourself and your decision. Affirming that humanity is deeply important for system-involved youth.
“So much of what young people actually are needing is people talking about: How are you connecting with people? What is feeling good and supportive and loving, and what is feeling coercive and manipulative in your life?”— Theo Isoz
You recently spoke on a webinar about the “car talk,” where caseworkers have windows of time while driving – taking a foster youth to court or an appointment – to ask them how they’re doing, or to check whether they’re getting information and services they need.
Let’s assume the caseworker or foster parent has earned trust. How should they start a conversation about relationships or sexuality, and what should they listen for or be sure to bring up?
Some of our methodologies will be to talk about “What are things that you’re seeing in your friends or your peers?” Sometimes they’re also talking about themselves. It’s just a window to talk about what’s going on in their lives. Most of the time, they’re actually talking about themselves.
Like, “I’ve got this friend who’s got a really burning question?”
Exactly. So you can ask: “Are any of your friends in relationships? And how are those relationships going for them? Are any of your friends sexually active and do they know where to access services? How might we support them in accessing those things?” Or asking, ”What are patterns you see around people in your school?”
Start with having that safety of being one person removed from the conversation. It’s giving them that opportunity to mull through those things in a less personalized way. It gives them the opportunity to deflect that intense stare that comes with a sexual health conversation.
What have been the differences you’ve observed or new practices you’ve had to adopt since transitioning from working in schools to now working with youth in foster care?
Frequently, the way we as sex educators talk about sexual health is we teach around values, and we refer young people back to their families to learn their values. But when we have young people in out-of-home care, that way of talking about sexual health becomes way more complex. It has to be so much more attuned. All sex ed needs to be trauma-informed, but this is like the deepest understanding of trauma and trauma histories.
There are times when we’re talking with young people who’ve been involved in “survival sex.” And that is a very different conversation about sexual health than we typically have in a classroom. That’s a pretty extreme example, but when we are working with young people in systems, that’s more likely.
We often talk about, “When you have sex, it’s important to think about protection.” But instead: “When you get the choice to have sex, if you’re having sex, you can think about protection.” Change that wording, recognizing that maybe not all the times that they’ve had sex was a choice.
What are the most common questions you hear from system-involved young people?
Questions often fall into some specific categories. There are lots of questions that are like, “Am I normal? Am I OK?” Things around sexual orientation, gender identity, but also body development and what’s normal and those sorts of things. “Am I beautiful? Will someone ever love me?”
We also get lots of questions that are just simply: “This is a thing I’ve heard of, but no one is talking about it. What is it?” Like, “I don’t even know what this means, but I hear this word around, so I’m going to ask you.”
Let’s say there’s a caseworker or a foster parent who’s just not comfortable talking about all of this with a young person. What’s most urgent for them to cover if nobody else will, even if they’re uncomfortable?
Even if someone isn’t comfortable and can’t have the conversation themself, it is still their job to support the youth in their life to make sure they have someone to talk to. I think there is an opportunity to help the young person by saying, “This is a big part of life. And it’s important that you have someone to talk to. So let’s talk about who are other trusted adults you could talk to.” Help that young person come up with those people.
We are societally conditioned to not talk about topics around sexuality and bodies and all of those things. Even I will have times where I get nervous. And I remind myself to feel the fear and to do it anyway.
You can even say to young people, “I am nervous about this. I’m uncomfortable because no one ever talked to me about this. But I think it’s really important.”
What are other big challenges for foster youth in getting any information? There can be a lot of chaos in their lives, but have you seen any other blocks to timely, appropriate, medically accurate, unbiased information?
I think there’s no one person who’s identified as the person to do it. Foster parents will say, “That’s not my job. I’m not their parent.” And in all fairness, they’re worried about overstepping, or they’re worried about what their role is. Or caseworkers might say. “That’s not my place.” Or any number of the people who are connected with this young person, parole officers, will say, “I’m a parole officer. I’m not a sex educator.”
That means that every person along the way has said. “That’s not my job.”
The continuous punting keeps them from ever quite getting the information. It can instill silence and shame, which have lifelong repercussions on a human and our future lives, selves, relationships. Even when we’re not talking about it, that is communication.
Were there any other issues you wanted to mention or advice that you have for youth or caregivers?
Young people have more power and more rights than they realize in our systems. They have many, many more rights than we often talk about. We need to be making sure that they know what their rights are so they’re receiving the care that they need, and so adults are aware of advocating for their rights.
Thanks for agreeing to this public conversation on these sensitive topics.
It’s a hard conversation to get folks to fully address — to across the board agree that we need to move this forward. Colorado has been successful in passing legislation around if you talk about sex education, what it must include. But saying that you must talk about it is nearly impossible.
And even states that have been able to pass that for schools have ended up with all sorts of lawsuits. So it’s a hot topic.