Sex under the age of 25 in residential youth care

Sex under the age of 25 is a large representative study done by Soa Aids
Nederland and Rutgers in 2005, 2012 and 2017 regarding the sexual health of
young people aged 12 to 25 years living in the Netherlands. These studies
resulted in rich datasets with information leading to a clear perspective on
sexual health among young Dutch people. However, specific subgroups of young
people were not included in these studies because of the used recruitment
methods (through secondary schools and the National population register). It is
concerning that young people living in residential youth care were not included
in the Sex under the age of 25 studies because they seem more vulnerable for
sexual risks and problematic sexual behavior. It has previously been shown that
young people living in residential youth care have relatively more experience
with sexual violence or family circumstances in which sexual development is not
supported. These and other factors result in the fact that young people living
in residential youth care experience more difficulties in having equal
relationships or in making healthy sexual choices. Several intervention were
developed specifically to support professional working with young people that
live in residential youth care because of their increased vulnerability for
sexual risks and problematic sexual behavior. However, research into sexual
health of these young people is lacking in the Netherlands. Existing
interventions are therefore based on studies among groups of young people that
are often living in residential youthcare, such as young people with mental
disorders or autism. The role of living in residential youth care on the sexual
health of these young people remains unknown.

This study results in new insights into the sexual health of young people aged
16 to 25 years living in residential youth care. These insights can be used to
improve interventions regarding sexual health that are used by professionals
who work with these young people.

Sex under the age of 25 years in residential youth care is a cross-sectional
participative action study.

Participation in research stimulates all stakeholders involved, increases
ownership of knowledge and commitment to future improvements to daily practice.
In the current study relevant stakeholders, like treatment coordinators,
professionals with specific focus on sexual health, researchers, policy makers
and managers, are included. They are involved in the design of the study, in
pretesting the questionnaire, in recruitment of participants and in translating
results into recommendations for daily practice and policy.

Prior to this study we have assessed the support and feasibility for this study
among relevant stakeholders. Points for attentions and possible obstacles in
executing this study were assessed. Multiple youth care institutions confirmed
the importance of this study and were prepared to participate. Prior to
customizing the questionnaire for the young people living in residential youth
care and prior to data collection we will visit several youth care
institutions. The aim of these visits is to familiarize ourselves with this
target group and with youth care institutions. During these visits we will
mainly familiarized ourselves with the institutions and the young people living
there. Additionally, an interview was held with one or more youth care
professionals about their needs and logistic challenges with regard to the
study for their institution.

For this study we need to customize research instruments to the abilities and
disabilities of the young people living in residential youth care. Previously
we have studied Sex under the age of 25 years among young people at secondary
special education. Cluster 4 schools educate students with severe behavioral
problems or psychiatric problems, problems related to the problems of young
people living in residential youth care. The questionnaire for this study will
largely originated from the questionnaire used in Cluster 4 of the secondary
special education schools.
The questionnaires that will be customized for young people in residential
youth care will be made suitable for young people with an IQ of 55 and higher
in terms of content and language. Young people with an IQ above 80 complete the
full questionnaire, while the young people with an IQ between 55 and 80 will
only complete a selection of the questions, in accordance with the PRO
questionnaire from the Cluster 4 group.
In selecting questions for the questionnaire we also need to take into account
that the sample is smaller than the regular Sex under the age of 25 years.
Therefore, questions that only concern small subgroups (for example young gay
people) will not be included because they will not result in meaningful
outcomes. Themes that will be included will be (online/offline) sexual
behavior, sexual experience, protection against pregnancy and STI, crossing of
sexual boundaries, knowledge, information requirement and use of social media
(including sexting). The questionnaire will be pretested among 20 young people.
In this pretest the questionnaire will be completed by the young people and
afterwards they will discuss their experiences in completing the questionnaire
with researchers.

The included young people need to complete a questionnaire. The young people
can have questions or develop some insecurities after completing the
questionnaire. They also might have negative experiences with sexuality
possilby making them feel confronted by the questionnaire.

The burden of completing the questionnaire is minimized by letting the
institution make a selection of who can and cannot participate. If the burden
is thought to be too high because of sexual trauma or severe psychiatric
problems, young people are excluded.

It might be possible that someone unexpectedly has an emotional reaction caused
by the questionnaire. Therefore, good healthcare after completing the
questionnaire needs to be available. Questionnaire supervisors (researchers or
ambassadors) will be trained how to deal with potential emotional responses
during completion of the questionnaire. Additionally, data collection will only
be done if the confidant of the department of the youth care institution is
available. If any of the young people need support they can immediately go to
the confidant.