Child Welfare Workers Knowledge, Attitudes, and Communication Patterns Regarding Sexual Health of Youth in Foster Care

Background: Elevated rates of early pregnancy and parenting among youth in foster care are well documented. For youth in foster care, whose engagement with systems that traditionally provide prevention and education may shift, the child welfare system is often the most proximal system through which to engage or reach this marginalized population. As the primary broker and facilitator of services for youth in foster care, child welfare is distinctively positioned to fill education and service gaps related to sexual and reproductive health. Yet, little is known about child welfare workers’ attitudes and knowledge related to sexual and reproductive health of YFC, or the extent to which conversations occur between child welfare workers and youth. This study (N = 201) aimed to: a) assess baseline attitudes, knowledge, and communication among child welfare workers regarding sexual health of youth, and b) examine direct and indirect effects of knowledge and attitude constructs on communications.

Methods: All participants were registered learners of trainings through the Colorado Child Welfare Training System between August 2018 and February 2019. Using the Theory of Planned Behavior with additional constructs from the Gateway Provider Model as a theoretical framework and measurement model, baseline surveys included three to eight items measuring the following constructs: behavioral beliefs, subjective norms, self-efficacy, knowledge of services, intentions to communicate, and past month communication. Items comprising each construct had strong internal consistency and were combined as mean scores. Descriptive statistics were used to assess these baseline constructs, and bivariate analyses were employed to investigate differences by demographic factors. Path analysis was used to examine how the constructs related, as well as direct and indirect effects of attitudes and knowledge on intentions and communication.

Results: On average, caseworkers had positive beliefs about the importance of these topics and their own ability to address them with youth in foster care. Levels of subjective norms and knowledge were moderate. Overall, participants reported intending to communicated with “a few” to “some” of their adolescent caseload, and communicating with 24% of their adolescent caseload in the past month. No differences were found on any constructs by demographic or employment factors. The path analysis revealed that subjective norms and self-efficacy had significant direct effects on intentions, and intentions were the sole statistically significant predictor of communication. Self-efficacy also had an indirect effect on communication that was mediated by intentions.

Conclusions: Results demonstrate that child welfare workers commonly encounter issues or concerns related to sexual health, though they appear to be addressed inconsistently. Self-efficacy and subjective norms emerged as the most important factors contributing to intentions and communication. Thus, in order to increase communication of caseworkers with youth regarding sexual health, interventions should focus on improving caseworkers’ confidence and comfort in approaching these topics. Additionally, findings on subjective norms likely indicate the need for clear administrative support and guidance on these topics in order for communication to occur.