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

Nixon, C., Elliott, L. and Henderson, M. (2019) 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. BMJ Open, 9, e025075. (doi:10.1136/bmjopen-2018-025075) (PMID:30975674) (PMCID:PMC6500194)

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Abstract

Objectives: To explore how personal and institutional factors promote or limit caregivers promoting sexual health and relationships (SHR) among looked-after children (LAC). In so doing, develop existing research dominated by atheoretical accounts of the facilitators and barriers of SHR promotion in care settings. Design: Qualitative semistructured 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 SHR training. Methods: In-depth interviews explored barriers/facilitators to SHR discussions, and how these shaped caregivers’ experiences of discussing SHR with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers’ understanding of their role. Results: SHR policies clarified role expectations and increased acceptability of discussing SHR. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted practice. Identified training gaps were how to: (1) Discuss SHR with LAC demonstrating problematic sexual behaviours. (2) Record the SHR discussions that had occurred in LAC’s health plans. Contrary to previous findings, caregivers regularly discussed SHR with LAC. Competing demands on time resulted in prioritisation of discussions for sexually active LAC and those ‘at risk’ of sexual exploitation/harm. Interagency working addressed gaps in SHR provision. SHR discussions placed emotional burdens on caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/ pastoral support and ‘safe care’ procedures minimised these harms. Conclusions: While acknowledging the existing level of SHR promotion for LAC there is scope to more firmly embed this into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing SHR policies and training, promoting interagency working and providing pastoral support are important steps towards achieving this.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Henderson, Dr Marion and Nixon, Miss Catherine
Authors: Nixon, C., Elliott, L., and Henderson, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BMJ Open 9:e025075
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
656571Sexual Health and Families ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/2IHW - MRC/CSO SPHU
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU
727641SPHSU Core Renewal: Setting and Health Improvement Research ProgrammeKathryn HuntMedical Research Council (MRC)MC_UU_12017/12IHW - MRC/CSO SPHU
UNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDSPHSU2UNSPECIFIED
UNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDSPHSU11UNSPECIFIED
UNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDUNSPECIFIEDSPSHU12UNSPECIFIED