Years have passed since I took care of 16-year-old Andy, but I’ll never forget him or his story.

As he sat in my exam room about half a decade ago, Andy, whose name has been changed, told me that his mom had kicked him out of the house when he told her he was gay.

He was 14.

He was my patient in the foster care clinic in South Los Angeles. The police had picked him up for prostitution. They took him to the Department of Child and Family Services, and he was placed in a group home.

He had been homeless and started prostituting so he could survive. He said because he was gay, he had been verbally and physically abused while living on the streets, including by men who paid to have sex with him.

Andy was African American and Latino, well groomed and very funny. His conversations were engaging and tragic at the same time. He bonded with the nursing staff and delighted in sharing beauty tips, especially eyebrow shaping.

His health problems were extensive including obesity and sexually transmitted diseases, but nothing rivaled his psychological trauma.

Sadly, Andy’s story isn’t unique.

Youth who are lesbian, gay, bisexual, transgender and questioning, known by the acronym LGBTQ, are over-represented among those who are homeless or in foster-care. This is due in part to rejection by their families, abuse and discrimination.

About a third of LGBTQ kids report suffering physical violence at the hands of their families. Many endure bullying or abuse from peers at school and adults in their communities. The maltreatment may be even more frequent for LGBTQ people of color.

While working in the foster care clinic, I cared for many LGBTQ kids. Their stories, like Andy’s, were heartbreaking.

As a pediatrician, I want to help every child live his or her best life. But, these kids had so many obstacles to overcome. Most of them had been ostracized from their families and communities and they were in pain. I wanted our clinic, the system, California—and, really, society—to do better for them.

I am encouraged that since I saw Andy, many national advocacy groups, as well as LA County, have taken steps to help these kids.

Cultural and community attitudes may contribute to the high number of LGBTQ kids of color in child protective services. Researchers have shown that religious beliefs can contribute to less acceptance of homosexuality among Latinos in the U.S., though more favorable attitudes have emerged in recent years. Compared to whites, blacks have higher disapproval of homosexuality, also commonly rooted in religious beliefs. These families may be less accepting of gender non-conforming children, leading to family disruption.

LGBTQ youth report experiencing additional verbal, physical or sexual abuse from foster parents or group-home peers and staff when they are placed in out-of-home care.

Every month in LA County, nearly 7,400 adolescents, ages 12 to 21, are in out-of-home care, including foster homes and group homes.

In 2014, 19 percent of foster youth reported being LGBTQ in a phone survey conducted by the Williams Institute. The participants were adolescents and young adults, ages 12 to 21, and were living in out-of-home care in LA County. About 80 percent of respondents were African American or Latino, similar to the demographics of all children and teens in the county Child and Family Services department. The Williams Institute is a national research institution at the UCLA School of Law.

The 19 percent rate is more than twice that of the 6 to 8 percent of students who self-identified as LGBTQ in a 2013 study in LA Unified School District.

Excluding questioning youth, LGBT foster youth had a higher number of placements and lower chances of finding a permanent home than non-LGBT youth. In addition, nearly one in eight LGBT respondents reported that they were “not treated very well” by the system.

Nationwide, the number of gender non-conforming youth in foster care isn’t known. Unlike other demographics, sexual orientation and gender identity statistics aren’t collected by most child-welfare agencies.

Child protective services face many hurdles for providing safe and supportive environments for LGBTQ youth, including bias and discrimination within the system.

LA County’s Department of Children and Family Services is actively working to change that.

“We are embracing all cases to meet the kids where they are,” said Charles Sophy, the department’s medical director. “Sexuality is just part of the palette of the child.” Sophy noted that his agency has initiated several programs to support LGBTQ youth.

“We do outreach to the community,” Sophy said. “We find foster and adoptive parents who want the kids” and fully accept them, he said.

The Los Angeles Gay and Lesbian Center is one of the partners with the department. They operate RISE (Recognize Intervene Support Empower) an innovative program that assists LGBTQ foster youth and their families. Many of the adults who volunteer can relate to the trauma that the teens are going through. The participants report that the group helps nurture understanding.

The Children and Family Services department is also working to increase training and awareness for their social workers, group home staff and foster parents. As part of a collaboration, the agency published a handbook for anyone involved in the care of LGBTQ youth. The overriding principle in the handbook is that every child who can’t live with his or her parents is entitled to a safe, loving and affirming foster placement.

Andy could never go home again, but therapy was helping.

His medical issues required several visits to our clinic, which was fortunate. We learned more about acceptance, and he developed relationships with adults whom he considered trustworthy.

When I last saw him, I was cautiously optimistic that he would go on to lead his best life.