Identifying Barriers and Facilitators of Implementing a Sexual and Relationship Health Intervention within the Child Welfare System: A Mixed Methods Study.

Access to sexual health education is critical for the wellbeing of youth in out-of-home care. HEART (Health Education and Relationship Training) is an online, evidence-based sexual health program that may benefit this group of youth, but reaching youth in the child welfare system remains challenging. This study aimed to identify barriers and facilitators to implementing HEART within the child welfare system. We used a convergent parallel mixed methods design and applied the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. We collected 1) qualitative data through semi-structured interviews with foster caregivers and child welfare professionals (n = 14) in one state in the United States; and 2) data through an online survey among youth in care (n = 72) across several states. Participants identified barriers and facilitators at four CFIR domains. Barriers included the religious and conservative beliefs of foster families and staff; the sensitive nature of discussing sex among youth who have experienced trauma; youth pushback to authority; and a lack of structure for offering youth sexual health education. Results provide a foundation for developing implementation strategies to implement HEART within the child welfare system.