Abstract
Introduction
Adolescents in crisis or foster care settings may lack access to inclusive, developmentally appropriate comprehensive sexuality education (CSE) due to stigma, inconsistent instruction, and limited opportunities for trusted dialogue. In 2025, Teen Health 360, in partnership with Tidewater Youth Services, piloted Get Real: Comprehensive Sex Education That Works at two group homes in Hampton Roads, Virginia, returning in 2026 following positive initial findings. This quality improvement initiative examined two years of implementation to assess feasibility, knowledge outcomes, and youth perspectives on CSE in group home settings.
Methods
During summers 2025 and 2026, Teen Health 360 delivered five sets of Get Real academy sessions, with each set consisting of 11 45-minute Get Real high school lessons to 33 adolescents aged 13–18 at group homes in Portsmouth and Virginia Beach. Topics included anatomy, healthy relationships, gender and sexual identity, consent, sexually transmitted infections (STIs), contraception, communication, and decision-making. Trauma-informed, interactive strategies included discussions, demonstrations, hands-on activities, anonymous questions, and communication skill-building. Mixed-methods evaluation included pre/post knowledge assessments, post-program evaluations, and focus group discussions (FGDs) with participants. Data were examined within and across implementation years.
Results
Thirty-three participants completed the pre-assessment, and twenty-seven completed the post-survey. Using post-survey data, participants had a mean age of 15 years (SD=1.27); 83% identified as male, 54% as Black, and 83% as straight. Attendance improved in 2026, when 62.5% completed all 11 lessons and 87.5% attended at least half, compared with 53% and 71%, respectively, in 2025.
Knowledge increased significantly from pre to post assessment. Mean knowledge scores (range: 0-14) increased from 6.48 (SD=2.16) to 8.67 (SD=4.32; p=.025), while the proportion correctly answering at least 11 items increased from 0% to 46.7% (p .001). Six individual items improved significantly, including HIV transmission (8.0% to 50.0%, p .001), legal consequences of sending nude images of minors (32.0% to 76.7%, p .001), and understanding of the term transgender (28.0% to 66.7%, p0.01).
Program experiences were highly positive: over 80% felt safe, viewed facilitators as knowledgeable, and felt comfortable expressing themselves and asking questions; 89% felt engaged. In 2026, 100% endorsed a safe environment, knowledgeable facilitators, and comfort expressing themselves and asking questions, compared with 61.5% in 2025 (all p .010).
Qualitative findings from FGDs indicated that youth valued interactive learning about STI prevention, condom use, healthy relationships, consent, and communication. Participants described actionable skills, including checking condom expiration dates, discussing STI testing with partners, communicating consent, and seeking support from trusted adults. They also identified gaps in peers’ sexual health knowledge and a need for accessible resources when approaching adults feels difficult.
Conclusion
Two years of implementation support the feasibility, acceptability, and educational benefit of interactive, trauma-informed CSE in group home settings. Consistent knowledge gains, positive feedback, and youth perspectives demonstrate the value of providing medically accurate information alongside practical prevention, communication, and help-seeking skills.
Sustained partnerships between health education programs and youth-serving organizations may help address gaps in access to trusted sexual health information. Future implementation should prioritize experiential learning, open discussion, and connections to trusted adults and preventive sexual health resources.