Reproductive Health
and Foster Youth
August 16, 2012
Leslie Starr Heimov, JD, CWLS
Children’s Law Center of California
Commissioner Anthony Trendacosta
Los Angeles County Superior Court
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Why We’re Here
Sex and romantic relationships are significant to normal
teen development
Sexual health is a tough subject
challenging for all adults
especially hard in dependency context
Sexual health issues can have major impact on teen
health and future plans
Dependency Court can have a powerful role, and is
trying to help
You can have a powerful role
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Percent reporting behavior
Sexual Activity Reported By
6th – 12th Grade Students*
Grade in School
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*Based on data from Project Connect, a study done with 26 LAUSD middle and high schools, 2005 – 2009.
Teen Pregnancy: Consequences
Birth and pregnancy in foster youth:
Foster youth become pregnant 2.5x non foster youth
2/3 of female foster youth gave birth within 5 yrs of emancipation
Foster youth with 5+ placements more likely to become pregnant
Children of single moms more likely to:
Grow up in Poverty
Become teen moms
Drop out of High School
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Sexually Transmitted Diseases
Chlamydia
Gonorrhea
Syphilis
Trichomonas vaginalis
HPV
Hepatitis A, B
HIV - fastest growing new diagnosis 20-24 year olds
Hepatitis C
Herpes
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Health Consequences of STDs
Infertility
Ectopic pregnancy
Pregnancy complications and congenital problems
Cancer
Chronic pain
Other chronic conditions or illnesses
Emotional and relationship issues:
Stigma/Long-term infections
DEATH
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Special Issues
Sexual orientation and gender identity
LGBTQ youth:
At higher risk for STDs, HIV, pregnancy
Many high risk behaviors
Young *MSM of color at especially increased risk for HIV
Also higher risk for depression, suicide
Abuse
History of sexual and/or physical abuse linked to higher
rates of STDs, HIV, and teen pregnancy
*(MSM- Men having sex with men)
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Sex and Relationships
are Significant to Normal
Development
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Tasks of Adolescence
Achieving independence from parents
(“leaving home”)
Adopting peer codes and lifestyles
Acceptance of one’s body
Establishing sexual, ego, vocational and
moral identities
Forming caring relationships with others
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Normal Development?
Easy to appreciate developmental role of other activities
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But Sex and Romantic
Relationships are Also Normal
Identity formation and validation
Social competencies learned and tested
Training in intimacy, mutual affirmation,
communication, negotiation
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The Adolescent Brain
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So is this normal development?
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How about this?
Where’s your comfort level?
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Sex is a Tough
Subject
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Challenges Talking About Sex
Both adults and teens are uncomfortable
Incest taboo
Neither wants to see the other as sexual
Adults are (appropriately) afraid of harm
Other normal teen traits problematic with sex
Risk-taking, sense of indestructibility
Impulsive, not thinking of long-term effects
Fear of coercion (especially with girls)
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vampire
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Challenges Addressing These
Issues with Dependent Youth
More than half of youth say they prefer getting sexual
health information from a parent or trusted adult
No one person may be in true parent role: there may
be no trusted adult
Chaotic lives may disrupt school sex education
Possible value conflicts among involved adults
History of abuse (sexual, physical) common
Abuse and lack of stability may exacerbate regular
teen sexual health issues
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Extra Significance of Sexual
Health for Dependent Youth
Chaotic lives can lead to increased longing for
love and need for a sense of belonging
Sexual relationships more likely to be a prime source of
validation
Increased risk of being abused or abusive
Need for acceptance can impact sexual health, e.g., getting
pregnant to keep a partner
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Special Challenges For All of Us
In parent role, but not actual parent
Limited time to engage with youth
Not a trained expert in this area
Lack of clear protocols or guidance
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But sexual health issues must
be addressed…
Because adults won’t be there when sexual health risks occur.
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Exercise:
When did you learn to drive?
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How to Use a Condom
Correctly
No genital contact before condom put on
Unroll directly onto penis (do not unroll first)
Unroll all the way to base
If no receptacle end, squeeze tip while unrolling
Do not flip over if started wrong side out
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What About Abstinence?
Q:
If I believe in abstinence before
marriage, isn’t that in direct conflict with
providing condoms to youth?
A:
No: Lessons from the “Drunk Driving
Contract”
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Like Any Other Behavior, Sex
Takes Practice
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CASE STUDY: ALEX
Alex is a 14 year-old boy in for regular
semi-annual appearance
Is uncommunicative
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Your Powerful Role
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Strengths and Opportunities of Dependency
Court Judges, Attorneys and Care Providers
Dealing with Sexual Health of Foster Youth
Consistent, long term presence, continuity
Can enlist support from other court-affiliated
professionals and staff to address sexual health
issues
Use immediate presence with youth to help
understand changes in their lives related to
sexuality
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How to Help Dependency Youth
Navigate Sexual Health
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What You Can Do (Generally)
Discuss that sex and relationships are a normal part of
development
Be a trustworthy adult youth can talk to - or help them identify
one.
Express your expectations and commitment
Overall goals specific to sexual development
Build good overall rapport
Express interest in youth as person, their feelings, etc.
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What is a Trusted Adult?
One who initiates discussions & listens
Needs to be able to address:
Relationships, dating
Options for the future more attractive than early
pregnancy and parenthood
Decision making & goal setting
Family planning and condoms
That youth should have a place they feel comfortable
going for reproductive health check-up and information
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Effective Communication
with Youth
Do:
Stress positive attributes of teen, praise good work
Deliver clear messages
Treat his or her comments seriously, resolve conflicts together
Inform communication by reflecting on your own experiences as a teen
Keep sense of humor
Don’t:
Compare with other teens
Lecture or moralize
Be judgmental or overly critical
Engage in power struggles
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Try to Avoid Phrases Like:
“The trouble with you is…”
“How could you do this to me…”
“In my day…”
“You’re wrong”
“That’s a dumb thing to say” (or feel)
“I’m so disappointed in you…”
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Expectations and Commitment
Related to Sexual Health: Some Examples
We want youth to be sexually healthy. That means they:
Take responsibility
Are in relationships where people treat each other with respect
Wait to have sex or become a parent because this will interfere with
goals and when they’re older they will be better at it
We also want youth to be prepared so that:
If they do have sex, they don’t get pregnant (or get someone
pregnant)
They don’t get STDs or HIV
They have the accurate information they need
Know about condoms
Know about family planning options
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More Examples:
Expectations about Abuse and Violence
We want youth to tell a trusted adult - you,
their lawyer, CASA, social worker, judge,
caregiver, teacher, therapist, etc. if they
might be in a relationship that is unsafe.
If someone is hurting or threatening them,
we want them to know that you can and
will help them.
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CASE STUDY: JUANITA
Juanita is a 17 year-old Latina whose Aunt is her
caregiver
She lives with her two younger sisters, and three female
cousins
Clear emphasis on heterosexual norms and traditional
ideas of femininity within the household
Aunt contacted social worker because she saw Juanita
kissing another girl
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Express Your Values and Expectations
Youth want guidance and to know what your values are about
sex
Take ownership of your values
There is room for your values and the Court’s efforts
There are many competing messages (media, friends, etc). You have a
special voice and authority: say “this is what I believe” or similar
There is no substitute for the one-on-one contact you can provide
Do what is comfortable for you
You don’t have to weigh in on sexual health, but YOU can be a positive
influence!
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Are you ready?
In Los Angeles dependent youth will now have access to
materials and resources including:
Brochures on various topics, including sexual health
Cards to help access Hookup Weekly text messages promoting
safe sex
Condoms
SWAG
Youth who choose to take materials or condoms will
leave court with the materials in a brown paper bag.
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We could never do that in ….
Colorado
Minors may consent to all reproductive health
services but notice required to at least one
parent for abortion
Illinois
Some minors may consent to contraceptive
services; minors may consent to STI services
& prenatal services; notice required to at least
one parent for abortion
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Or in…….
Florida – Judge Cohen & Judge….
Connecticut
Some minors may consent to contraceptive
services; minors may consent to STI services &
prenatal services; notice required to at least one
parent for abortion
Minors may consent to STI services and
abortion but not contraception unless they are
married
DC, New Mexico
Minors may consent to all reproductive health
services
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Georgia
Minors may consent to reproductive health
care, but for abortion at least one parent
must be notified, and doctor may (but is not
required to) choose to notify parents of STI
treatment
Michigan
Minors may consent to prenatal and STI
treatment; doctor may (but is not required
to) choose to notify parents. Parental
consent required for contraception (unless
married) and abortion.
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Texas and Utah
Only married minors may access their own
contraceptive services, but no state funds
may not be used to fund the services.
Minors may consent to their own STI and
prenatal care; but in Texas the doctor may
but is not required to, choose to notify
parents of prenatal care.
Parental notice and consent required for
abortion.
For more detailed state specific information
go to: www.guttmacher.org/statecenter/
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Getting Started
Data, Data, Data
Find a champion
Judge
Child Welfare Leader
Advocacy
Organization
(including youth led
organizations)
Elected Official
Community Leaders
Build Relationships
County or State
Department of Health
Free Clinic
Adolescent Health
Expert
University Department
of Public Health
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Questions??
#1 Juan (age 12):
#2 Danielle (age 15):
Juan returns from court and says, “I got some condoms
today at the court - what are they for?”
Danielle fills her bag with brochures and condoms but says
nothing.
#3 Alex (age 16):
Alex says, “I got 10 condoms at court and I’m going to use
them all tonight!”
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Contact Us
Leslie Heimov
heimovl@clcla.org
www.clccal.org
323-980-5762
Commissioner Trendacosta
atrendac@LASuperiorCourt.org
323-526-6446
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Resources for Professionals
page 1 of 2
National Council of Juvenile and Family Court Judges,
www.ncjfcj.org (775) 784-6012
“When You Decide,” A Judge’s Guide to Pregnancy Prevention
Among Foster Youth (includes checklists)
Critical Judgment: How Juvenile and Family Court Judges Can
Help Prevent Teen and Unwanted Pregnancy
Ten Things Every Juvenile Court Judge Should Know About
Trauma and Delinquency
Public Health Institute, www.phi.org (510) 285-5500
Sex Education and Reproductive Health Needs of Foster and
Transitioning Youth in Three California Counties
No Time for Complacency, Sexual Health Needs of California’s
Foster and and Transitioning Youth, Spring 2009
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Resources for Professionals
page 2 of 2
California Adolescent Health Collaborative (a PHI project),
www.californiateenhealth.org (510) 285-5712
National Center for Youth Law, www.youthlaw.org (510)
835-8098
Promoting the Sexual and Reproductive Health of Adolescents in
Foster Care
Consent to Medical Treatment for Foster Children: California Law
A Guide for Health Care Providers, December 2008
L.A. County Department of Public Health
An Epidemiologic Profile of HIV and AIDS in Los Angeles County
2009, http://publichealth.lacounty.gov/hiv
Los Angeles County Sexually Transmitted Disease Morbidity
Report, 2010, http://publichealth.lacounty.gov/std/reports
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Resources for Parents and
Caregivers
The National Campaign to Prevent Teen and Unplanned
Pregnancy, www.thenationalcampaign.org (202) 478-8500
10 Tips for Foster Parents to Help Their Foster Youth Avoid Teen
Pregnancy
Children Now, Talking with Kids About Tough Issues,
www.childrennow.org/index.php/learn/talking_with_kids
(510) 763-244
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Resources for Youth
Teen Source, http://teensource.org
Planned Parenthood, http://www.plannedparenthood.org
MTV’s It’s Your Sex Life, http://www.itsyoursexlife.com
www.HaveSexStandingUp.com
Sex Etc. (by teens for teens), http://www.sexetc.org
It Gets Better Project (for LGBTQ youth), http://www.itgetsbetter.org
Go Ask Alice (Columbia University),
http://www.goaskalice.columbia.edu
www.DontThinkKnow.org
www.bedsider.org
LA County STD Hotline: 800-758-0880
HIVLA – testing and treatment resources in LA, http://www.hivla.org
Text CLINIC +ur zipcode to 61827 to find clinics near u
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