Despite taboos and a tense political climate, a group of former foster youth, sexual health educators and experts in child welfare and violence prevention have teamed up to further awareness.
HIGH STAKES, SILENT SYSTEMS: Read more from The Imprint’s series on sexual and reproductive rights in foster care.
Six years ago, when Zoë Jones-Walton was about to turn 18, she sat in a windowless Dallas-area conference room with dozens of other foster youth. A series of lectures on how to navigate adulthood covered the gamut: How to write a check, how to land a job, how to get an apartment — and how to avoid unwanted pregnancies. That exercise involved placing a condom on a banana to learn about safe sex.
“They put everything in this one week and you’re supposed to just be like — ‘OK, I’m going to remember all this when I’m out on my own in the world,’” said Jones-Walton.
Now 25 and working as an advocate, she noted dryly: “I haven’t.”
A recent study commissioned by the federal government found foster youth face “disproportionate risk of poor sexual health outcomes.” But — like many of her peers nationwide in the child welfare system — Jones-Walton received only scant information about intimacy and relationships. The banana demonstration was the first and only lesson she received on that front, she recalled in a recent interview.
These days, Jones-Walton is part of a unique push to broaden this critical guidance for teenagers in the state’s custody. The Texas Foster Youth Health Initiative’s efforts involve smaller groups of 10 to 15 young people and weekly discussions rather than a one-time lecture.
Jones-Walton is considered a rising star among child welfare advocates. She was invited by the initiative to help design its lessons covering basic sex ed, healthy relationships, setting boundaries and giving and receiving consent.
While many such curriculums emphasize the risks of sex through what Jones-Walton calls “the scare approach,” the Health Initiative is tailored to meet the needs of teenagers in the foster care system, who often suffer from traumatic experiences and shifting homes and caregivers. The Texas curricula were developed by former foster youth, child welfare and violence prevention experts, sexual health educators and foster parents from across the state.
Carlie Patrick, a 27-year-old preschool teacher and former Texas foster youth is among those consulted on the project. Growing up, she said she was on her own for sex ed — particularly given the silence on the topic in the Christian homes where she was placed.
Since then, “it’s been really nice to be a part of creating that safe space,” Patrick said. “Teaching people how to talk about this topic without prejudices and biases allows children to make their own choices.”
Lessons such as these are rare nationwide, and even more unusual in the conservative state of Texas, where lawmakers have restricted school sex ed curriculums, particularly instruction on gender identity and LGBT-related topics. An Imprint investigation published in May revealed that child welfare agencies nationwide require little or no instruction on issues related to reproductive health, intimate relationships or the prevention of sexually transmitted infections.
The information void is troubling given the disparities foster youth face: Compared with the general population, young people raised in the child welfare system are at higher risk of inadequate health care access, relationship violence and difficulty building trusting relationships.
“These conversations are not happening,” said University of Texas at Austin Research Scientist Barbara Ball, one of the leaders of the Foster Youth Health Initiative. “We’re not talking, we’re responding to youth behaviors that adults deem risky. That’s sort of the general way people have been operating.”
While the federal Department of Health and Human Services has invested billions of dollars to fill the gap in teen pregnancy prevention programs over the past decade, those efforts typically target broad populations through schools and other community settings. The Texas Health Initiative is one of only two specifically serving foster youth through a competitive Office of Population Affairs innovation grant aimed at promoting cutting-edge approaches to prevent teen pregnancy.
Ball’s program has received nearly $5.6 million since 2020 to operate in the San Antonio, Dallas, Rio Grande Valley and Houston regions, under a three-year grant concluding this year.
Recent data have underscored the need for information and support: Last year, the number of pregnancies among Texas foster youth hit a five-year high, state data show. The population of older youth is also sizable. Among roughly 28,000 children in Texas foster care as of late 2021, more than 6,000 were at least 13 years old, according to federal data. There are also stark racial disparities in the counties the initiative serves, underscoring the need for tailored competence in discussing these sensitive issues: In seven of the state’s largest counties — including three where the Health Initiative operates — Black children are nearly twice as likely to be in foster care.
When asked for her input, Jones-Walton thought about her own experience with foster parents, who approached the topic based on their personal or religious beliefs, rather than any standard of care. She said she was put on birth control even though she wasn’t sexually active. Until then, she hadn’t even considered having sex.
When Jones-Walton had the opportunity to help other foster youth navigate similar situations through the Texas Health Initiative, “I thought, yeah, this is extremely important,” she said.
“Teaching people how to talk about this topic without prejudices and biases allows children to make their own choices.”— Carlie Patrick
Ball started her career in schools teaching about dating violence. When she joined Professor Monica Faulkner — an expert in pregnancy and parenting in foster care — at the Texas Institute for Child and Family Wellbeing, they quickly recognized the need to improve upon what had been scattershot interventions for foster youth.
Often, professionals in the child welfare system shied away from the topic, they found.
“People are afraid of re-traumatizing foster youth; we’re always anticipating the negative outcome. And we really miss important opportunities to teach them what their rights are for a healthy relationship, for a consensual sexual experience,” said Ball. “So we have really tried to chip away on that.”
Youth advocates say traditional teen pregnancy prevention programs emphasize individual behavior, and assume there will be rational, planned decision making: Show kids scary pictures of sexually transmitted infections, for example, and they will adjust their behavior to avoid them. Sexual health curricula developed in the past decade now bring more nuance to the conversations.
Ball’s program and others — such as the youth-led, statewide coalition in California called the Reproductive Health Equity Project for Foster Youth — acknowledge the contexts and disadvantages faced by youth coming from marginalized low-income communities, and entering a system that makes decisions about their lives through court orders.
In addition to centering foster youths’ needs, the Health Initiative in Texas focuses on supporting child welfare professionals and foster parents, who often lack information on how best to approach sensitive topics.
“There are resources out there, but we know that youth-supporting professionals have trouble finding, accessing and using that information,” said Jan DeCoursey, project director for Activate, a reproductive health organization specifically serving professionals working with young people who have been homeless, disconnected from school or experienced the child welfare and justice systems.
DeCoursey, whose team publishes the Sexual and Reproductive Health Resource Explorer database, said she is “impressed and appreciative” that the federal Office of Population Affairs is supporting sex ed programs for foster youth in Texas and California that are designed and implemented together with impacted young people.
Activate’s tip sheets for professional caregivers nationwide urge frank conversations. But they also advise against “trying to ‘know everything’ when discussing sexual and reproductive health with youth.” Caregivers are advised to “seek needed information in partnership with the youth.”
The Foster Youth Health Initiative in Texas relies on a similar team approach, and has received positive feedback from participants. The program has served more than 300 caregivers and roughly 150 foster youth to date, and is looking to expand into other states.
Patrick, the Texas initiative’s youth advisor, says the work needs to continue. She speaks with hard-earned self-possession about her own searing experience in foster care, including a pap-smear the local agency required — without explanation and despite her objections.
After the procedure, she said she, her doctor and adoptive mother “sat down and just cried together because it was traumatizing for all of us.”
These days, teaching toddlers at a daycare in the San Francisco Bay Area, Patrick emphasizes the importance of boundaries, even for 2-year-olds.
The lesson is called: “Stop, Don’t Touch My Body.” Tots learn to firmly hold their hand up, palm out, like the universal stop sign.
It’s a lesson she wishes she had received growing up in foster care.
“Communicating with my biological mother was not an option,” Patrick said. “I got all of my information from reading romance novels — which is not the way to learn about sex.”