The stress of abuse and neglect, being in the foster care system, and living outside of one’s home can have profound effects on a child’s physical development and wellbeing. Numerous studies have overwhelmingly found a correlation between childhood trauma and physical health issues that manifest in adulthood. Such research shows that the more adverse experiences a child has, the more at risk they are of developing unhealthy habits such as smoking and alcohol dependence as well as health issues such as diabetes, liver disease, stroke, and asthma. Additionally, placement changes can sometimes result in missed medical appointments and healthcare needs slipping through the cracks.

One of the known protective factors that can significantly reduce a child’s risk of developing health issues is working with a caring adult outside of the family, such as a CASA. CASAs can play a direct role in supporting their youth’s health and wellbeing by encouraging healthy lifestyle choices, expanding their access to health-related resources and opportunities, and ensuring they receive adequate medical support.

How to Advocate

There are many different ways a CASA can actively support their youth’s physical health needs, both behind-the-scenes and directly with their youth. Check out some of our ideas below!

Behind-the-scenes:

Connect with their public health nurse. Each youth is assigned a public health nurse to assist with their medical needs, from making appointments to referring them to specialists to participating in medically-related CFT meetings. Ask the social worker to connect you with this individual so you can begin partnering with them on all things health.
Track your youth’s last medical, dental, and vision appointments and record in your Advocate Link survey. Was their last appointment more than a year ago? Talk to their caregiver and team about scheduling a new one. See our Legal section below to learn more about their rights to appointments like these.
Ensure the youth’s Health and Education Passport is up-to-date. If your youth is living out of the home, they will have a Health and Education Passport (HEP) that tracks their medical and education histories. It should be updated each time something like a medical appointment or a school change occurs. A copy of the HEP can be provided by their county social worker upon request.
Make sure your youth is re-enrolled each year in Medi-Cal by their social worker. Note that if your youth is a non-minor dependent and they move out of San Francisco County, they are responsible for applying for their own Medi-Cal, not their social worker.
Make sure your youth or their caregiver has their Medi-Cal card on hand.
Work with the team to connect your youth to healthy extracurricular activities and resources. This can include joining a sports team, taking cooking lessons, buying a bike, etc. – whatever your youth is interested in! Please check out our “Financial Support” page to learn about grant funding that can be used to cover these needs.

With your youth:

Help them track any physical health symptoms.
If appropriate based on their age, help them set up medical appointments and keep copies of their medical records and prescriptions.
If they are a non-minor dependent moving out of county, help them re-enroll in Medi-Cal.
Talk to them about their medical rights. See our Legal section below to learn more.
Start a conversation with your youth about:
- Exercise
- Drinking water
- Sleep
- Nutrition and the importance of eating veggies
- Dental hygiene
- Self-care
Incorporate physical activity and nutrition into your activities together, such as:
- Walk in their neighborhood
- Hike in a local state park
- Do a charity walk/run
- Visit a farmer’s market to learn about and shop for local fruits and vegetables
- Go grocery shopping and cook a healthy meal
- Exercise at the gym
- Take a yoga class
- Head to the park to throw a Frisbee, play on the jungle gym, or kick a soccer ball around
- Garden
- Go on a walking meditation
- Rollerblade or go ice skating
- Jump around at a trampoline gym
- Go for a bike ride

Advocating for Orthodontic Care

Our youth are covered by Denti-Cal, or the dental version of Medi-Cal. While Denti-Cal covers routine dental cleanings and medically necessary dental procedures, the insurance rarely covers the cost of braces (except in cases of extreme medical need). If it is determined that your young person requires braces, be sure to submit a payment request to Denti-Cal first, if this request is denied other options are available!

The Human Services Agency (HSA), has limited funds available to pay for braces and orthodontic care for our youth through a special payment request. Speak with your young person’s PSW for more information on the payment request.

Western Dental, in San Francisco, provides dental services for youth in dependency and also performs free orthodontic assessments in an effort to determine if braces are required. When this assessment is completed, be sure to ask Western Dental for something called an HDL score. This score can be used to request special funds from HSA. Work with your youth’s Public Health Nurse to advocate for these funds through HSA. If you are unsure of where to start with dental, orthodontic, or general medical questions pertaining to your young person, please start with the Nurse of the Day Hotline via telephone at 415-558-2656 or via email at NOD.Line@sfgov.org.

Appropriate language to use as a CASA

Bias abounds when it comes to physical health and nutrition. As a CASA, it is crucial to approach your youth’s physical health needs in a nonjudgmental, culturally humble, and body positive manner. For example, has your youth gained weight recently? Perhaps it was caused by a new medication that causes a weight increase or depression. Have you observed an eating habit that you don’t personally agree with? Your youth may be using it as a coping tool or soothing strategy.

Ultimately, you will want to support the youth’s agency to make their own healthy choices while encouraging a healthy lifestyle and self-care. Make sure to avoid approaches like telling your youth why a certain behavior needs to change and how, emphasizing your own personal reasons for change, or “fixing” a problem you see.

Instead, focus on approaching this subject with your youth using strategies like open-ended questions to invite discussion, such as “What do you like to do to move your body? How does that food make you feel?”, and follow these questions up with active listening and validation to ensure there is an atmosphere of acceptance. Within this safe space, explore and harness their own personal motivation and confidence in their abilities, empowering them to advocate for their own needs and make healthy lifestyle choices that work for them as an individual.

Please reference this resource from California CASA for more tips on how to navigate conversations with your youth.

Legal Rights

Medi-Cal

The majority of youth in foster care are eligible for Medi-Cal, which is California’s Medicaid program. A youth’s Medi-Cal eligibility begins the moment their dependency petition is filed, and Medi-Cal processing is expedited so they can access services immediately. This covers their medical, visual, and dental needs.

The Affordable Care Act provides Medicaid up to age 26 to youth who age out of foster care. To qualify, individuals must have been in foster care on their 18th birthday. If a non-minor dependent moves out of the county, they are responsible for transferring their Medi-Cal, not their social worker. Find out more and how to apply here.

Appointments

Youth in out of home placements must receive a medical examination within 30 days of initial placement. After this visit and completion of any necessary medical treatment, checkup visits should occur annually.

Youth in out of home placements must receive a dental examination within 30 days of initial placement. After this visit and completion of any necessary dental treatment, preventive visits are needed every six months. Note that dental exams are required for children beginning at age 3 years and above.

Consent

While entry into the dependency system does not automatically remove a parent’s right to consent to his or her child’s health care, the court does have the authority to remove a parent’s right to consent to medical care once a minor is declared a dependent child. This must be done through a court order. California law allows additional people to consent for a dependent’s health care at times. This does not mean the parents or other person who holds primary consent rights have been divested of their authority. Rather, the law simply provides additional options to ensure necessary services can be provided in a timely manner. Additional approved options include the court, as well as the youth’s social worker and caregiver.

Beginning at age 12, youth are able to consent to the following: drug and alcohol abuse treatment; diagnosis and treatment of infectious, contagious, or communicable diseases; and the testing and treatment of HIV. Beginning at age 15, youth are able to consent to vaccinations (with the exception of some vaccinations that prevent against sexually transmitted diseases like HPV).