Evaluation of a Sexual Health Training for Child Welfare Workers

Background: Elevated rates of early pregnancy and parenting among youth in foster care (YFC) are well documented. Training child welfare workers to provide sexual health information and resources is stated throughout the extant literature as a pressing need in efforts to prevent unintended pregnancy among YFC. However, few child welfare agencies offer such training to their workers, and little is known about the extent to which conversations about sexual and reproductive health already occur between child welfare workers and youth. Thus, this study aimed to: a) assess baseline attitudes, knowledge, and communication among child welfare workers regarding sexual health of YFC, b) examine how these constructs are interrelated, and c) evaluate the preliminary effectiveness of a sexual health training for child welfare workers by comparing those who received a sexual health training (n = 69) to those in other (non-sexual health) trainings (n = 132) on knowledge of services, attitudes towards communicating with youth, and past month communication about sexual health topics with YFC. Methods: All participants were registered learners of a training through the Colorado Child Welfare Training System between August 2018 and February 2019. Baseline and 3-month follow-up survey data were collected from intervention participants who registered for the sexual health training and comparison participants who registered for non-sexual health trainings. Surveys included three to eight items measuring child welfare workers\u27 behavioral beliefs, subjective norms, self-efficacy, knowledge, intentions to communicate in the current month, and past month communication with youth on their caseload regarding sexual health. Items comprising each construct had strong internal consistency and were combined to create mean scores. Descriptive and bivariate statistics were used to assess baseline constructs, path analysis was used to test relationships between the constructs, and regressions were used to examine the impact of the intervention on each outcome. Results: At baseline, on average, caseworkers reported that they had discussed sexual health with 24% of their adolescent caseload in the past month. 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 regarding sexual health. Self-efficacy also had an indirect effect on communication that was mediated by intentions. In analyses examining intervention effects, participants in the sexual health training showed more positive behavioral beliefs, self-efficacy, and knowledge compared to date- and region-matched comparison participants at the 3-month follow-up; there was no difference between the groups on intentions or communication. Conclusions: Results demonstrate that self-efficacy and subjective norms are key constructs leading to caseworkers\u27 intentions and communication regarding sexual health topics with YFC. Further, it is promising that the sexual health training increased behavioral beliefs, self-efficacy, and knowledge 3 months after the intervention. In order to influence the primary outcome of workers\u27 communication with YFC regarding sexual health, additional intervention components may be needed such as administrative supports, policy changes, or booster trainings