SFCASA Advocacy Areas
Wellbeing, Access to Healthcare
Why We Advocate
As youth develop and grow into adulthood, it is common for some to develop a mental health condition that can impact their well-being and day-to-day functioning. Research shows that 1 in 5 teens and young adults struggle with their mental health, with half developing a mental health disorder by age 14 and three quarters by age 24. There are many layers of biological and social factors that can influence a youth’s mental health, one of which is the process of coming into foster care.
Trauma and Mental Health
Out-of-home placements disrupt healthy attachments at any age and often remove a sense of security and stability that is vital to a person’s wellbeing and identity. The trauma of being removed from the home, coupled with the experience(s) that brought them into care in the first place, can place a strain on a youth’s mental health that can have significant repercussions for other aspects of their life, from relationships to school to placement. Trauma sends negative messages to a youth, which become internalized as negative feelings and behaviors.
Because trauma can both mirror mental health disorders and exacerbate or trigger existing conditions, to be in foster care means a youth is at a higher risk of developing psychological and emotional issues than the general population. Foster youth are three times more likely to receive a mental health diagnosis than their non-foster youth peers; research shows that nationally up to 70% of juvenile justice-involved youth and 80% of youth in foster care experience significant mental illness, in comparison to 18-22% of the general population.
Foster youth are often inadvertently caught in a vicious mental health cycle; if they are struggling with their mental health and exhibit certain behaviors, they may be removed from their placement, suspended or expelled from school, hospitalized, and/or placed on psychotropic medications. Each of these experiences has a high likelihood of retraumatizing the youth and exacerbating their mental health struggles.
Diagnoses and Forms of Support
While it can be difficult to diagnose young people because their brains are still developing, foster youth nonetheless may receive a number of diagnoses. These include mood disorders (such as depression or bipolar disorder), anxiety disorders, psychotic disorders (such as schizophrenia), personality disorders, eating disorders, trauma-related disorders (such as post-traumatic stress disorder), developmental disorders (such as ADHD and autism spectrum disorder), behavioral disorders (such as oppositional defiant disorder), substance use disorders, and obsessive-compulsive disorders.
Foster youth either receive or should be receiving support in managing their mental health needs. This support can include a variety of modalities, such as psychotropic medication; traditional therapeutic support like behavioral therapy, cognitive behavioral therapy, play therapy, and child-parent psychotherapy; and non-traditional therapeutic support like equine therapy and recreational activities. Any treatment that a youth’s team explores should be trauma-informed and culturally rooted.
As mentioned above, psychotropic medications, which affect the central nervous system to treat psychiatric disorders, are one form of support for youth with high behavioral needs. Different medication types include antidepressants, antipsychotics, mood stabilizers, anti-anxiety medications, and stimulants.
Psychotropic medication can be a valuable tool to provide stability and promote well-being when used as a part of a larger treatment plan and when other evidence-based treatment options have been tried. Psychotropic medications should not be used as a first line of treatment, alone without other forms of non-medication support, or to mask the side effects of different medications.
The use of psychotropic medication to treat behavioral health needs has skyrocketed over the last decade for foster youth, who are disproportionately prescribed such medications. Studies indicate that foster youth are prescribed psychotropic medications 3 to 11 times more than non-foster youth, and approximately 70% of those on medication are prescribed two or more from different medication classes. There have been many issues identified with prescribing psychotropic medication for foster youth, such as too many medications being prescribed (known as polypharmacy, which is a layering of medication), too high of dosages, little to no monitoring, and prescribing based on inaccurate diagnoses. When any one of these issues arises, it can be unsafe for the youth, potentially resulting in long-term and permanent health issues.
CASAs can and should play a central role in advocating for appropriate oversight of psychotropic medication usage in foster youth. While the number of foster youth being prescribed psychotropic medication in California has declined in recent years, those youth still on medication need support from their team, including their CASAs, to ensure they are being prescribed medications safely and effectively.
How to Advocate
As a CASA, remember that it is not your job to diagnose a youth or act as their therapist or doctor. However, there are many different ways a CASA can actively support their youth’s mental health needs, both behind-the-scenes and directly with their youth. Check out some of our ideas below!
Determine if your youth is being prescribed psychotropic medication. If so, please review these resources to inform your advocacy:
Comprehensive list of best practices (from the American Academy of Child and Adolescent Psychiatry)
SFCASA Psychotropic Medication Advocacy Webinars (please scroll down to view this webinar series in “CE Opportunities” below)
If your youth is in an out-of-home placement, obtain a copy of their latest Health and Education Passport (HEP) from their social worker. This documents their academic information as well physical and mental health status, detailing any known diagnoses and treatments like psychotropic medications and dosages.
Determine if your youth is receiving therapy services and if so, what type(s). A CASA can learn this through discussion with the youth’s social worker, Wraparound care coordinator, and/or clinician. It can also be determined by reviewing the latest Status Review Report and the Health and Education Passport (HEP). Be prepared to advocate for any obstacles that prevent therapy from taking place, such as transportation issues or access to a culturally-appropriate clinician.
Speak to the youth’s team about what types of mental health assessments have taken place, such as a psychological evaluation or a CANS (Child and Adolescent Needs and Strengths) assessment. The CANS assessment is a tool that helps a foster youth’s team determine the level of care and services they may need, including mental health needs.
Connect with relevant mental health professionals on your youth’s team in order to ask relevant questions and gain relevant information (please review this document for guidance on important questions to ask various team members). This can include:
The public health nurse at the Human Services Agency. Each youth is assigned a public health nurse at the Human Services Agency 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.
The psychiatric nurse specialist at the Human Services Agency, if they are being prescribed psychotropic medication. Your case supervisor can connect you with this person, who will be a good point person should you have any questions about their medication and related mental health services.
Their prescribing physician if they are being prescribed psychotropic medication
The individuals on their Wraparound team
Their school’s Foster Youth Liaison to ensure their mental health needs are being met in the school setting.
If they are being prescribed psychotropic medication, work with the team to ensure there is a treatment plan in place that pairs medication with therapy services. Additionally, make sure they are receiving regularly check-ins about the treatment plan.
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.
Learn the warning signs of mental illness and a mental health crisis to feel prepared to identify any possible concerns when working with your youth. Share any concerns about your youth’s behaviors with your case supervisor immediately. These may include changes in their eating and sleeping habits, low energy; withdrawal from people and activities; frequent complaints about physical symptoms like stomach aches, headaches, feeling tired; and schoolwork decline.
Make sure to add all relevant mental health information to the “Health” section of your court report. It is appropriate to list information here about their therapy services, any medications they are on, and any observations you have.
Remember that youth are not their diagnosis!
With your youth:
Establish a safe and supportive environment. This can be accomplished through setting boundaries, showing up regularly and building structure, being consistent in messaging, and modeling positive and healthy relationships.
Encourage the expression of their feelings. This can be accomplished by validating the feelings your youth may be indicating or sharing and helping your youth to identify their feelings. If you suspect that your youth is struggling with their mental health, ask them questions like, are you feeling sad? Are you thinking about hurting yourself/have you ever thought about hurting yourself?
Support their use of positive, constructive coping skills and self-regulation. This can include self-care, mindfulness, and practicing breathing techniques. Please be in touch with your youth’s clinician if they have one to learn if they are working on any regulation tools that you can support during visits or should be aware of.
Explore trauma-informed, healing activities with your youth that can have a therapeutic effect. This can include:
Doing a body scan and practicing deep breathing
Taking a body movement class together, such as yoga, boxing, dance or self-defense
Creating and decorating a family tree or family photo album
Journaling and writing or telling stories
Participating in a team sport such as soccer
As appropriate, start a conversation with your youth about:
If they are being prescribed psychotropic medication, help them track any symptoms or side effects of the medication. This information can help inform the JV-218, a legal form that the youth should be completing for each psychotropic medication hearing that states their opinion about their medication. Please review this document for guidance on important questions to ask your youth.
If they are being prescribed psychotropic medication, advocate around psychotropic medication hearings, which happen every six months if your youth is being prescribed medication. This advocacy should entail knowing when the hearing is taking place and working with their social worker to ensure they are filling out a JV-224 (County Report on Psychotropic Medication) and filing it along with a JV-218 (Child’s Opinion about the Medicine).
Talk to them about their mental health rights. See our Legal section below to learn more.
Appropriate language to use as a CASA
Each youth’s response to trauma and their mental health challenges can be different, and it is important to recognize that many behaviors, coping skills, and communication patterns are tied to this. It is vital that CASAs take a nonjudgmental, strengths-based approach when it comes to supporting their youth’s behavioral health needs, and recognize that a person is not defined by their behaviors.
Do not be intimated to ask open-ended questions of both your youth and their team to invite discussion about your youth’s mental health needs. With your youth, 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 about how to navigate a conversation with the foster youth you serve.
Resources/links to learn more
Facts for Families Guides by the American Academy of Child & Adolescent Psychiatry
NAMI (National Alliance on Mental Illness)
Foster Care Mental Health Program (a part of San Francisco’s Department of Public Health)
Seneca Family of Agencies (provides Wraparound care for many San Francisco County foster youth)
Edgewood Center for Children and Families (provides Wraparound care for many San Francisco County foster youth, also provides acute intensive services)
Bay Area Youth Line: 888-977-3399
California Youth Crisis Line: 800-843-5200
San Francisco Suicide Prevention Hotline: 415-781-0500
SFCASA Psychotropic Medication Advocacy Webinars
To learn about how CASAs should be involved in psychotropic medication advocacy work for San Francisco foster youth, please watch the webinars below. 1 CE credit each.
Psychotropic Medication for Foster Youth: An Overview of the Legal Process
Psychotropic Medication for Foster Youth: How and Why CASAs Should Advocate