Identifying Barriers and Facilitators of Implementing a Sexual and Relationship Health Intervention within the Child Welfare System: A Mixed Methods Study.
Brasileiro J, Widman L, et al. • Journal of sex research • 2025
This study identified barriers and facilitators to implementing the HEART online sexual health program within the child welfare system, finding obstacles including religious/conservative beliefs, trauma-related sensitivity, youth pushback to authority, and lack of structural support for sexual health education.
Key Findings
Methods
The study used a convergent parallel mixed methods design guided by the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementing HEART within the child welfare system.
Qualitative data were collected through semi-structured interviews with foster caregivers and child welfare professionals (n = 14) in one U.S. state
Quantitative data were collected through an online survey among youth in care (n = 72) across several states
The CFIR framework was applied to guide both data collection and analysis
A convergent parallel mixed methods design was used, meaning qualitative and quantitative data were collected simultaneously and then integrated
Results
Religious and conservative beliefs of foster families and staff were identified as a barrier to implementing sexual health education within the child welfare system.
This barrier was identified by foster caregivers and child welfare professionals during semi-structured interviews
This barrier was categorized within the CFIR domain framework
The finding reflects tensions between evidence-based sexual health programming and the values of gatekeepers in the foster care environment
Results
The sensitive nature of discussing sex among youth who have experienced trauma was identified as a barrier to implementing HEART.
Youth in the child welfare system have often experienced trauma, which complicates the delivery of sexual health content
This barrier was identified across participant groups including foster caregivers and child welfare professionals
This finding highlights a unique challenge specific to the child welfare population compared to general youth populations
Results
Youth pushback to authority was identified as a barrier to implementing a sexual health intervention within the child welfare system.
Youth resistance to authority figures was noted as an implementation challenge
This barrier was identified through both qualitative interviews with professionals/caregivers and survey data from youth
Survey data from 72 youth in care across several states contributed to identifying this barrier
Results
A lack of structure for offering youth sexual health education within the child welfare system was identified as a systemic barrier to implementation.
The child welfare system was found to lack established mechanisms or protocols for delivering sexual health education to youth in care
This structural gap was identified by child welfare professionals and foster caregivers (n = 14) through semi-structured interviews
This barrier operates at an organizational or systems level within the CFIR framework
Results
Barriers and facilitators were identified across four CFIR domains, providing a foundation for developing implementation strategies for HEART within the child welfare system.
The CFIR (Consolidated Framework for Implementation Research) organizes implementation factors into multiple domains
Findings spanned four of the CFIR domains, indicating that implementation challenges are multi-level
The authors describe the results as providing 'a foundation for developing implementation strategies to implement HEART within the child welfare system'
HEART (Health Education and Relationship Training) is described as an online, evidence-based sexual health program
Background
Access to sexual health education is identified as critical for youth in out-of-home care, yet reaching this population through the child welfare system remains challenging.
Youth in out-of-home care are identified as a group that may particularly benefit from HEART
The study was conducted in the context of the United States child welfare system
The study situates the need for implementation research as driven by both population vulnerability and access challenges
What This Means
This research suggests that delivering sexual health education to young people in foster care or other out-of-home placements faces multiple overlapping challenges. The study examined an online sexual health program called HEART and looked at what makes it hard or easy to offer this program within the child welfare system. Researchers interviewed foster caregivers and child welfare workers, and also surveyed young people in care across the United States. They found four main types of barriers: the religious or conservative values of many foster families and staff, the difficulty of talking about sex with young people who have experienced trauma, resistance from youth toward authority figures, and the absence of any established system or routine for providing sexual health education in child welfare settings.
This research suggests that simply having a good sexual health program is not enough — the environment and people surrounding youth in foster care play a major role in whether they can actually access it. Gatekeepers like foster parents and agency staff hold significant influence over what programs youth are exposed to, and their personal beliefs or discomfort can act as real obstacles. At the same time, the child welfare system itself lacks clear pathways for routinely offering this kind of education.
This research suggests that future efforts to bring sexual health programs into child welfare settings will need targeted strategies that address these specific barriers — including ways to engage foster caregivers with varying values, trauma-informed approaches to sexual health content, and system-level structures that normalize and support youth access to this type of education. The findings are intended to help designers and policymakers create more effective plans for reaching this underserved group of young people.
Brasileiro J, Widman L, Norwalk K, Desmarais S, Wechsberg W, Seebaluck K, et al.. (2025). Identifying Barriers and Facilitators of Implementing a Sexual and Relationship Health Intervention within the Child Welfare System: A Mixed Methods Study.. Journal of sex research. https://doi.org/10.1080/00224499.2025.2457445