Children and young adults in the child welfare system are more likely to visit the doctor for wellness checkups than their peers, yet just over half of pregnant youth receive prenatal care.
California state officials revealed new data today showing that young people in the nation’s largest foster care system are being better-served when it comes to sexual and reproductive health care, but key shortcomings remain in services for pregnant and parenting youth, particularly youth of color.
The first-of-its-kind analysis follows years of advocacy by the National Center for Youth Law, California’s statewide Reproductive Health Equity Project for Foster Youth and other groups, as well as numerous legislative reforms on behalf of adolescents in government care. The report details youths’ access to information and services with noteworthy depth.
Reproductive health experts and children’s rights advocates hailed the unprecedented public reporting requirement and its resulting information, included in a 2021 statewide reform law.
“This helps us to be able to see where youth need more support,” Elyzabeth Andersen, a youth board member of California’s statewide Reproductive Health Equity Project for Foster Youth coalition, said in a statement. “We’re able to take action and make changes and see if that action actually is making a difference or not when we have a report to look back on each year.”
Andersen added that the report — titled “Performance and Outcome Data on the Implementation of Sexual and Reproductive Health Training and Education” — could serve as a powerful new accountability tool. “Like, ‘OK, you’re saying you’re doing this, and you’re saying you’re helping — but do the statistics show that or not?’”
The report released by the California Department of Social Services combines data from the state’s Medicaid agency, known as Medi-Cal, and its county-run child welfare systems, comparing foster youth outcomes in 2020 against other low-income teenagers with the same public health insurance. Foster youth 10 to 20 years old received comprehensive check-ups with doctors — “well-care” visits recommended by the American Academy of Pediatrics — at a far higher annual rate than the broader Medi-Cal population: roughly 63% compared to their peers at 47%. The report also shows nearly all of the state’s more than 200 juvenile court judges hearing foster care cases — 96% — have received new training in sexual and reproductive health.
There were other areas of concern, however. The rates of essential medical visits for pregnant and parenting foster youth, who studies find to have double or triple the rate of their peers not in foster care, lagged behind other teens. Just 55% of pregnant foster youth received prenatal care visits during their first trimester, compared to 64% among their peers. Medical visit rates were lowest for pregnant foster youth identified as white or Hispanic.
Emilio Valladolid, another youth board member with the Health Equity Project, described the risks of a “tidal wave” pregnant foster youth experience. “It’s like if you miss one step you kind of have all of these consequences that can affect the rest of the steps you take,” Valladolid said in a statement posted on the website of the California-based National Center for Youth Law. “So it’s not one of those things where you can say ‘OK, we’re doing good enough.’ No, if there is one issue, there are multiple issues.”
While the new report shows foster youth were only slightly more likely to deliver a low birth-weight baby, foster youth identified as Black saw the highest rates. Twelve percent of their babies were small, compared to 7% of babies born to other youth on Medi-Cal. California officials describe that gap as a “critical priority” to understand and better address.
The lawmaker who championed the state’s new annual reporting law, the Healthy Futures for Foster Youth Act, said in a statement that the first edition contains “invaluable information” for improving the outcomes for California residents in foster care.
“It is disheartening to see the disproportionately poorer outcomes for ethnic foster youth,” said Democratic Assemblymember Blanca Rubio of the San Gabriel Valley, outside Los Angeles. Rubio also noted a “critical underutilization” of public benefits available to these expectant parents. But she added that she was confident the report provided a strong foundation for future improvements.
An Imprint investigation published in May, “High Stakes, Silent Systems,” revealed that dozens of states lack policy guidance to support foster youth with the information they need as they go through puberty. An analysis of tens of thousands of pages of child welfare policy manuals revealed little or no mention of healthy relationships and sex education, or the rights of foster youth to access contraception and abortion. The exposé found numerous examples of states with rules for foster youth that conflict with all minors’ legal rights to access abortion or contraceptives.
Earlier this year, the federal Administration for Children and Families published a report declaring foster youth to be “a population at disproportionate risk of poor sexual health outcomes.” The description follows decades of concern among public health and social work professionals about high rates of coercive sex and unintended pregnancy among young people growing up in child welfare systems. Sex educators have emphasized the need for a careful, tailored and thorough approach to conversations about intimacy and relationships with system-involved young people, whose lives are marked by frayed or severed family bonds.
Lonnell Schuler, a former foster youth, sex educator and program coordinator for the Los Angeles nonprofit Black Women for Wellness described the inadequacy of the status quo in conversations this past year for The Imprint’s investigative series: “There seems to be an assumption that parents or schools are handling this, but that’s often not the case,” Schuler said.
Sarah Pauter, a San Diego-based former foster youth who works for the nonprofit John Burton Advocates for Youth described the impact from a young person’s experience. “You grow up in the foster care system, with a caseworker, in a doctor’s care — you might have lots of people in your life — yet you have no idea about your own body and what you are going to experience very soon,” she said. “This is the culmination of failures within our education system when it comes to sexual health education, and also in our child welfare system.”
The state’s new report arrived nearly 10 months past its legislative deadline of Jan. 1, and it doesn’t include breakdowns by age, sexual orientation, placement type or other key characteristics. The state agency was not able to provide required data on how many foster youth receive sexual health education and staff training data was incomplete from Los Angeles County — the state’s largest child welfare system. Meanwhile, in 2021, none of the California probation officers working with foster youth who leave the justice system reported taking the required sexual health training course that judges and social workers are also required to take.
Still, in The Imprint’s nationwide review, California stood out for its robust number of recent state laws and regulations: Following a new statewide plan to address unplanned pregnancy, Senate Bill 89 in 2017 required foster care caseworkers to receive training to support adolescents, and to document that foster youth have received comprehensive sex education either through schools or private providers such as Planned Parenthood or Teen Talk. In 2021, Assembly Bill 172 required the new annual public data report on the law’s implementation. Agency regulations and guidance in recent years have refined and expanded on those and other new state laws.
California’s powerful lobby of children’s advocacy organizations pushed for many of these reforms, and continues to shape them as part of a working group, together with state agencies: The National Center for Youth Law, the Alliance for Children’s Rights, Black Women for Wellness Action Project, Children’s Law Center of California, John Burton Advocates for Youth and the Reproductive Health Equity Project.
One national expert praised the progress demonstrated by the report released this week in California.
“I can say without a doubt this is the first of its kind published by a state agency,” said Angelique Day, professor at the University of Washington’s School of Social Work. “We need to make sure we are educating health care professionals advocating for treatments that take into consideration the mobility changes our youth are facing to ensure they don’t lack access to these critical health care supports.”
Another expert cited in the Department of Social Services report said she was “shocked” by the dramatic policy changes in her home state on a topic that has challenged foster care systems nationwide. Janine Bruce, executive director of the Office of Child Health Equity at the Stanford University School of Medicine’s pediatrics department, conducted doctoral research almost a decade ago that found widespread confusion among caseworkers about youths’ needs and rights and staff responsibilities. Only two of the 26 California counties she studied had policies ensuring the sexual and reproductive health of foster youth.
That appears to have changed. Bruce added: “I can’t believe the tremendous amount of work and progress that is being made at the state level.”