Providing sex and relationships education for looked after children: a qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity conflict and overload among caregivers

Research output: Contribution to journalArticle

Accepted/In press

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Original languageEnglish
JournalBMJ Open
StateAccepted/In press - 5 Mar 2019


Objectives: To explore how personal and institutional factors promote or limit the role of caregivers in promoting sexual health and relationships among looked-after children (LAC). In so doing existing research that is dominated by atheoretical, accounts of the facilitators and barriers of sexual health promotion in looked after settings.

Design: Qualitative semi-structured interview study.

Setting: UK social services, residential children’s homes and foster care.
Participants: 22 caregivers of LAC, including 9 foster carers, 8 residential carers and 5 social workers; half of whom had received sexual health and relationships training.

Methods: In-depth interviews explored barriers/facilitators to sexual health and relationships discussions, and how these shaped caregivers’ experiences of discussing sexual health and relationships with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers’ experiences of their role.

Results: Sexual health and relationships education policies clarified role expectations and increased acceptability of discussing sexual health and relationships. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted their practice. Identified training gaps were how to: 1) discuss sexual health and relationships with LAC demonstrating problematic sexual behaviours and 2) record that sexual health and relationships discussions had occurred in LAC’s health plans.
Contrary to previous findings, caregivers regularly discussed sexual health and relationships with LAC. Competing demands upon time resulted in prioritisation of discussions for sexually active LAC and those ‘at risk’ of sexual exploitation/harm. Interagency working was used to address gaps in sexual health and relationships education provision. Sexual health and relationships discussions placed emotional burdens upon caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/pastoral support and ‘safe care’ procedures were used to minimise these harms.

Conclusions: Whilst acknowledging the existing level of sexual health promotion for looked-after young people there is scope to have this more firmly embedded into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing sexual health and relationships policies and training, and promoting interagency working and the use of pastoral support are important steps towards achieving this.