Kinship Support Program Summary Data Analysis and Implications 2016-2018

Prepared by the YMCA of San Diego County, Youth & Family Services

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Grandma D is a 67-year-old, single grandmother who lives in East County and recently stepped in to raise her 2-year-old grandson, Isaac, after he was removed from his biological mother’s care. Raising a grandchild comes with many challenges, but Grandma D was facing extra barriers. Not only had Isaac experienced trauma while in the care of his mother, but he also had several special medical needs, including a feeding tube, a hearing aid, and a small boot on one foot, that required him to go to several appointments at Rady Children’s Hospital every week.

To make things even more challenging, Grandma D’s only vehicle had been impounded, so Grandma D and little Isaac were forced to ride the bus for two hours, each way, to get to and from appointments. At one point, Isaac was hospitalized, and Grandma D took the bus to the hospital to visit him every day.

When Grandma D connected with the YMCA Kinship Support Program, her Kinship Navigator knew that something had to be done to alleviate some of the challenges Grandma D faced on a daily basis. Grandma D’s Navigator helped her sign up for respite care in order to get a break from her caregiving responsibilities and helped her enroll in CalWORKs and CalFRESH to receive monthly financial assistance for food and other basic needs items. These resources were a great support for Grandma D and Isaac, but transportation was still a daily challenge. Luckily, Grandma D’s neighbor was willing to sell her a reliable, used car for just under $2,000. Grandma D used some savings to pay half of the cost, and Kinship Support Program Emergency Funds covered the rest. Not only did a reliable method of transportation make it much easier for Grandma D to take Isaac to and from his appointments, but she was also able to take on more house-keeping jobs, which lead to more financial stability.

Despite the challenges associated with caring for Isaac, Grandma D was completely committed to providing a safe, stable, and loving home for him. The services she received from the Kinship Support Program were able to make an incredibly difficult but important job a little easier.

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EXECUTIVE SUMMARY Kinship caregivers are a diverse group of individuals, but they are united in that they are all stepping in at a moment of crisis and caring for children who have experienced traumatic events and can no longer be raised by their biological parent(s). Kinship care has become increasingly important because research shows children fare better when they can remain in the care of a family member instead of entering the traditional foster care system.

Children can come into kinship care in a variety of ways. Children are either placed with a relative through Child Welfare Services (CWS) or an informal arrangement has been decided by the family outside the jurisdiction of Child Welfare, which determines whether or not their caregiving arrangement is considered “formal” or “informal”. While all kinship families face the same challenges specific to raising children that have endured adverse experiences, the amount of assistance kinship families are eligible for depends on their systems involvement (with CWS and/or courts) and is, ultimately, inequitable.

The YMCA of San Diego County, Youth & Family Services, believes that how a child came into Kinship Care should not limit the amount of support a caregiver receives to provide a safe and supportive environment in order to offset the trauma they have experienced.

The program serves hundreds of caregivers each year, regardless of their level of need and caregiving arrangement, to ensure that San Diego’s most vulnerable children remain connected to their biological family and are surrounded by a stable environment that promotes healing and leads to better outcomes throughout life.

The organization has provided supportive services for kinship families since 1999 and has been funded by contracts with the federal government and County of San Diego, Health and Human Services Agency since 2009 and 2014, respectively.

The program recently completed an analysis of its data to better understand the families it serves and the needs they have upon coming into contact with the program. The findings of the analysis are presented in this report to contribute to the field of services for this unique family structure.

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KINSHIP CAREGIVERS Families Served By YMCA Kinship Support Services from 2016-2018 This report analyzes data from unduplicated families upon first contact with the YMCA Kinship program in fiscal years 2016-2017 and 2017-2018. Data were collected at intake to provide a snapshot of needs identified by both informal and formal Kinship families over the course of two years.

933 total number of Kinship caregivers served

total number of self or community referrals

1,073 551 total number of total number of Child referrals Welfare Services referrals

522

66%

Nature Of Caregiver Relationship to Children *Can be great/great-great grandparents or aunts/uncles

23%

Grandchildren*

Nephews/nieces*

5%

3%

2%

Non-relative extended family members

Siblings or half siblings

Cousins

Legal Arrangement showsthe thelegal legalrelationship relationshipthe thecaregiver caregiverhad hadtotothe thechild childatatthe thetime timethey they The graph below show started services services with with the the YMCA YMCA Kinship Kinship program. program. started 53% System Led (Child Welfare) Arrangement

47% Family-Led “Informal” Arrangement 47%

•

53%

• • •

No Legal Arrangement/Court Involvement (36%) Probate Court Guardianship (8%) Family Court Custody (2%) Independent Adoption (1%)

• • • •

Juvenile Court Dependency Case (33%) No Court Involvement: Prevention & Voluntary (9%) Juvenile Court Guardianship (8%) Juvenile Court Adoption CWS (3%)

Top Three Reasons for Kinship Care Primary Reasons Why Bio Dad Is Not Involved

Primary Reasons Why Bio Mom Is Not Involved 37%

Substance Abuse (n=235)

9%

8%

Mental Health (n=57)

Incarcerated (n=53)

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20%

20%

Substance Abuse (n=117)

Unknown (n=118)

16%

Incarcerated (n=97)

Average Monthly Household Income $5,000-or more $4,000-$4,999 $3,000-$3,999 $2,000-$2,999 $1,000-$1,999 $1-$999

9% 8% 12% 21% 25% 10%

Federal Poverty Line (FPL) Estimated 4 out 10 families served live under the FPL for a

family of four (annual household income less than $25,100)

Emergency Funds (EF)

By Type of Care

Top Four Family Needs 42% Public Assistance The YMCA Kinship Program surveyed caregivers to identify the family’s needs upon entry into the program.

Evaluation efforts revealed the following data, averaged across two years.

Emergency Funds are used to purchase items and services needed to remove barriers to making or maintaining stable kinship placements.

38% Childcare 16% Education

$105,015 Informal Care

10% Health Care

$334,482

Healthy Families Parenting Inventory (HFPI) Percentage of caregivers demonstrating concerns in the following HFPI domains averaged across two years.

16%

15%

Parent/Child D epression Behavior

15%

13%

11%

Formal Care

$439,497 Total Amount of EF

Top Three Ways EF Were Used z zz

Personal

Social

Parent

42% Bed/Cribs

Care

Support

Efficacy

(n=475)

11% Rent

14% Childcare

(n=131)

(n=163)

“I don’t remember ever sleeping in my own bed.”

— child in kinship care, who experienced homelessness with her parents and sister prior to moving in with her aunt. The kinship family received emergency funds to purchase bunk beds for the sisters.

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BACKGROUND Kinship caregivers are relative or non-relative family members who unexpectedly assume the role of primary caregiver for a child after a significant barrier – like substance abuse, mental health challenges or incarceration – prevents the child from being raised by his or her biological parents.

The circumstances that led to placing a child in kinship care, such as child abuse/ neglect, absence of one or both biological parents, and exposure to substance abuse, are considered adverse experiences that can have a traumatic effect on children and impact their development. According to researchers, “trauma occurs when a person perceives an event or set of circumstances to be extremely frightening, harmful, or threatening—either emotionally, physically, or both.”1 When a child experiences adversity and the trauma that results from those circumstances, especially when it occurs early in life and is chronic or severe, their stress response system over-activates and exhausts the body and brain over time. Persistent stress impacts the young brain and is the primary way in which adversity impairs development.

The resulting trauma has been linked in numerous studies to a variety of high-risk behaviors, chronic diseases, and negative health outcomes in adulthood.

However, exposure to adversity does not predetermine poor outcomes, and proper support —particularly the consistent presence of a warm, responsive caregiver — mitigates the impacts of trauma. When parenting with access to supportive resources and sufficient financial funds, kinship caregivers can cultivate and maintain an environment that helps the child build resilience and promotes healing.

Nationally, 33% of children in foster care are placed with relatives.2 In San Diego County, that number is higher than the national and statewide figures (46.7% in 2017) due to local efforts and recent legislation to prioritize kin-caregiver placements over traditional foster care because relative care results in better outcomes for the youth involved. According to The Annie E. Casey Foundation, a nationwide leader in child welfare and kinship research, children in kinship care are better able to adjust to their new environment, less likely to experience behavioral problems and mental health issues, and experience fewer school disruptions than children in non-kin foster care.

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Bartlett, J.D, & Sacks, V. (2019, Apr. 10), Adverse childhood experiences are different than child trauma, and it’s critical

to understand why. Retrieved from https://www.childtrends.org/adverse-childhood-experiences-different- than-childtrauma-critical-to-understand-why 2

Williams, S.C. & Sepulveda, K. (2019, May 21). The share of children in foster care living with relatives is growing.

Retrieved from https://www.childtrends.org/the-share-of-children-in-foster-care-living-with-relatives-is- growing

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While all kinship families face the same challenges specific to raising children that have endured adverse experiences, the amount of assistance kinship families are eligible for depends on their caregiving arrangement and is, ultimately, unequal.

Kinship families are often considered “formal” or “informal” based on how the children were placed in the care of their relative. While all kinship families face the same challenges specific to raising children that have endured adverse experiences, the amount of assistance kinship families are eligible for depends on their caregiving arrangement and is, ultimately, unequal.

Raising children is expensive and requires significant investments of time, energy, and attention, and statistics reveal that caregivers often take in children on short notice, are offered no training to raise children that have experienced trauma, and receive limited financial assistance to meet basic needs.

The YMCA of San Diego County, Youth & Family Services, believes that the method of placement into kinship care should not determine the level of support caregivers receive.

All caregivers require adequate support to ensure that the children in their care can grow up in a safe and supportive environment that offsets the trauma they have experienced.

The program serves hundreds of San Diego’s caregivers each year to ensure that all children in kinship placements remain connected to their biological family and are surrounded by a stable environment that promotes healing and leads to better outcomes throughout life.

YMCA Youth & Family Services has been serving kinship caregivers since 1999 and developed the current program model as the result of a federal demonstration project awarded in 2009. That combined experience led to a contract with the County of San Diego, Child Welfare Services, to provide a continuum of support for relative and nonrelative extended family members in San Diego County under the Kinship Support Program. The program helps caregivers manage the transition when children are placed in their care, access resources, and receive support to stabilize the placement and eliminate the need for involvement with the Child Welfare System.

To ensure caregivers are able to maintain a safe, stable environment for the children in their care, the YMCA Kinship Support program offers: • Needs assessments to identify barriers to legal and relational permanency.

• A trauma orientation to educate caregivers about the impact of trauma and how it can manifest in challenging behaviors. The orientation also facilitates referrals and connections to additional community resources to address trauma needs.

• Information and referrals to community resources to meet the needs of caregivers

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• Kinship Navigation and Case Management to aid caregivers in the complex processes involved in applying for public benefits, engaging with the Child Welfare System, accessing special education services in schools, navigating the court system, and securing other resources needed to stabilize placements.

• Weekly support groups in eight regions of the county and quarterly recreational family activities to enhance social connections among caregivers and their children.

Groups also offer peer emotional support and increase resilience for adults who have endured adverse experiences in their own childhoods.

• Respite care for caregivers over the age of 55 to support the caregiver’s ability to care for the child long term.

• Emergency Funds for a one-time need to cover newly incurred expenses associated with the child(ren) in their care, such as childcare or a bed for the child. Funds are provided to remove any barrier to making or maintaining the placement with a relative.

Supportive services contribute to the long-term health and well-being of the caregiver and ensure the child can remain in that kin-placement and realize the benefits of a warm, responsive relationship that fosters resilience and leads to success throughout life.

METHODOLOGY In 2016-2017, the YMCA received 510 referrals, 210 of which were connected to YMCA Kinship Navigation services. In 2017-2018, the YMCA received 563 referrals, 353 of which were connected to YMCA Kinship Navigation services.

The YMCA contacts all referrals received, though not every referral needs in-home navigation services. Some families only require a light touch service such as a one-time referral to resources, respite services, or access to support groups or other amenities.

Other families decline navigation services, report that they are not ready to engage in any services at the time, or do not respond to attempts to contact them.

Families that do move into the navigation phase complete an assessment to identify their needs and possible barriers to stability. This report analyzes assessment data from unduplicated families upon intake with the YMCA Kinship program in fiscal years 20162017 and 2017-2018. Data were collected once to provide a snapshot of the needs facing different families over the course of two years.

CHARACTERISTICS

Reasons for absence of biological parents Table 1 in the appendix represents a cross tabulation of the primary reason a parent is not involved, by bio parent gender and in order of frequency of primary reason based on aggregated data from FY 16-17 and FY 17-18. Substance abuse and incarceration were the most common reasons for lack of biological parent involvement, in addition to mental health issues, which affected biological mothers more often.

The majority of caregivers surveyed (66.4%) were classified as grandparents raising grandchildren. Aunts or uncles raising nephews and nieces comprised the second highest

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(23.1%) caregiving arrangement, followed by non-relative extended family members raising children (4.95%), siblings/half-siblings raising siblings (3.25%), and cousins raising cousins (2.3%).

Kinship families can fall into two categories – formal or informal – depending on their level of involvement with the Child Welfare System. Formal caregiving situations are those where the child has an open dependency case in Juvenile Court. Informal caregiving situations are those with no Child Welfare system involvement. For YMCA Kinship, formal caregivers comprised 53% of families served, and informal caregivers comprised 47% of kinship families served in both fiscal years.

FAMILY NEEDS When caregivers assume responsibility of a relative child, their lives change dramatically and permanently. Day-to-day routines involve new and unexpected responsibilities, and the caregiver is suddenly responsible for a child’s basic needs, education, and physical and mental health. Caregivers step in at a time of crisis and meet an immense need in the child’s best interest, so the YMCA Kinship program wraps around the caregivers as soon as they request it and provides emotional and peer support, one-time financial assistance, and access to resources to maintain a safe, stable home for the child in their care.

As part of the YMCA of San Diego County, the YMCA Kinship Program can leverage a variety of resources that further contribute to the well-being of kinship caregivers and the children in their care. At a minimum, families in the YMCA Kinship program are offered membership to the recreational YMCA branch of their choosing for $10-$15 per month, a rate lower than the typical income-based scholarships for families. Families are also offered a 50% discount on YMCA enrichment programs, such as swimming lessons, sports leagues, and camps to contribute to the child’s overall development. Several support groups take place at YMCA branches throughout the YMCA of San Diego County county, which are safe and easily accessible for participants. They are also connected to other agency offerings, including childcare referrals through YMCA Connection to trusted Childcare Resource Service, overnight camps at 3 family-focused locations throughout the county, day-long camps organization at any branch convenient to the caregiver’s home, and additional assistance to connect them to public Referrals to other benefits (financial and health insurance), guardianship community services assistance, basic needs items, respite assistance, social support via support groups, mental health Overnight and services, housing programs, and youth development day-camp programs activities.

The YMCA is synonymous with bringing families together, and that name recognition and reputation adds legitimacy to services provided and instills a sense of trust among families who may be skeptical of working with public agencies.

Child Care Referrals Discounted YMCA Memberships Familiar and easily accessible locations for support groups

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CONCRETE NEEDS YMCA Kinship surveyed caregivers served during the evaluation period to identify the pressing issues facing families upon entry into the program. Evaluation efforts revealed the following data, averaged across two years:

39% of caregivers rarely or never had affordable childcare for the children in their care, and 36% lacked high quality childcare.

Background: Families in San Diego County, both kinship and biological, face multiple barriers to accessing childcare. First, the supply of childcare spaces does not meet the estimated need. A 2018 study by the University of San Diego revealed that 44% of children, ages 0-5, with caregivers who are employed did not have a spot in a childcare facility in 2017,³ and spaces for infants and toddlers are particularly impacted. Further, while the majority of families (83%4) require full-time care, the majority of subsidized childcare providers only offer part-time care.

The price of childcare is another significant barrier for families already facing financial constraints. In California, the average cost of full-time infant care is $15,513 and full-time preschool averages $10,807 per year – approximately 60% above the national average.5 Implication: The multiple obstacles to accessing quality, affordable childcare make it difficult for kinship caregivers to adequately meet all the needs of the children in their care. Quality in early learning requires a keen understanding of a young child's brain, effective interactions to nurture developmental relationships, healthy eating and physical activity, and screenings to identify any developmental challenges in early stages. Childcare should not only provide a supervised environment for children; it must foster optimal development so young children enter kindergarten ready to thrive.

Access to quality childcare settings also allows caregivers to continue working while their children are given the best foundation to succeed in school and life. The needs of kinship families are dynamic and diverse, and caregivers must be able to access the care at the frequency and schedule that best suits their needs. Affordable childcare is essential to stabilize placements and ensure that kinship caregivers are able to maintain a stable environment for the children in their care.

The recently developed Foster Care Bridge program has given caregivers access to shortterm financial support to cover childcare expenses, however, this benefit is only available to formal caregivers, meaning all informal (47% of those served) caregivers in the YMCA Kinship program do not qualify for Foster Care Bridge. In response, our program ensures that caregivers access subsidized childcare in a timely manner through the Centralized

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Caster Center for Nonprofit and Philanthropic Research, A Study of San Diego County Local Child Care Needs and Barriers, May 2018 4

Data from YMCA Childcare Resource Service, San Diego County’s Child Care Resource & Referral Agency

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California Child Care Resource & Referral Network, 2017 Child Care Portfolio

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Eligibility List, which is managed by YMCA Childcare Resource Service (CRS). A Kinship Navigator walks caregivers through the entire process, helping them fill out the application online, coordinating with YMCA CRS to verify the application was received and is complete, and asking for an estimated timeframe of when the childcare subsidy will begin. At the same time, the Kinship Navigator can apply for Emergency Funds to immediately cover the cost of childcare until the subsidy is available. Without this support, the caregiver would be left paying out of pocket for childcare. In other cases, caregivers do not have the option of taking time off work or paying out of pocket, which jeopardizes the child’s ability to remain with a relative caregiver. Immediate childcare assistance is vital to the caregiver so that they can continue to maintain employment and be able to provide ongoing stability for the kinship children.

37% of caregivers rarely or never received public assistance to financially support the children in their care.

Background: The 37% of caregivers who rarely or never receive public assistance mainly reflects the formal families who are waiting for RFA funds to be disbursed and the informal families who are trying to access CalWORKs (cash aid), MediCal (health insurance), and sometimes CalFRESH (food stamps). CalFRESH provides aid for caregivers that is consistent whether they have a formal or informal kinship arrangement and is always based on family income. Other benefits are based on the child’s income, which is often $0 unless they have Supplemental Security Income (SSI) or other private support.

The nuances of eligibility requirements for each benefit and the status of the kinship arrangement can influence how much cash aid a caregiver receives for the child in his or her care. While a caregiver may qualify for all the benefits as a low-income individual, an informal placement status disqualifies the family from receiving the same level of financial assistance as formal resource families for the same amount of caregiving responsibility.

This issue is magnified when a caregiver takes in multiple kin-children to the point where a caregiver with 3 children in an informal arrangement, for example, receives less financial support than a caregiver with 1 child in a formal arrangement.

Typically, caregivers do not receive public benefits for reasons that include: lack of awareness that they qualify for public benefits, difficulty navigating bureaucratic systems, and lack of appropriate documentation such as a birth certificate to prove a blood relationship between the child and caregiver or proof of legal guardianship. In some cases, caregivers receive inaccurate information from the eligibility workers and are told they do not qualify based on the eligibility requirements for biological parents. The public benefits system was built around nuclear families, which causes some eligibility workers to screen out kin-families unintentionally.

Some caregivers also struggle with the stigma of accessing public benefits to support the Kinship children they are now raising. For grandparents raising their grandkids especially, complex family dynamics also influence their decision to decline CalWORKS for financial support. Since CalWORKS is a form of child support, the caregiver’s adult children could be required to repay the County for benefits provided.

Many caregivers report that they struggle with this decision because garnishing wages for repayment will impede their adult child’s path to stability and self-sufficiency.

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Kinship Caregivers who unexpectedly assume responsibility for multiple children or sibling groups experience increased financial obligations, and that is exacerbated when caregivers have their own children, are retired, or are living on a fixed income. Public assistance eases that financial burden, but Kinship caregivers, no matter what form of public assistance they receive, have significantly less financial support than what the United States Department of Agriculture (USDA) estimates it costs to raise a child.

Implication: Public benefits provide caregivers access to While foster care critical resources (housing assistance, health care, food aid, etc.) that allow them to invest in the development and wellpayments cover 52% being of the children in their care. To successfully secure of the true cost of additional financial resources for their family, caregivers raising a child, TANF must have access to systems navigation and emergency payments only cover funds to address gaps in eligibility or wait times before 25% of the true cost receiving public assistance. A Kinship Navigator confirms their eligibility for specific public benefits, walks them of raising one child, through the bureaucratic processes to sign up for public or just 17% of the benefits, and educates them about the requirements to true cost of raising receive payments as a resource family, the new Statetwo children. level designation for foster and kinship families. Kinship Navigators educate informal families about their eligibility for benefits, accessing required documents if needed, and how to apply. Formal resource families do not need to apply for benefits, so Kinship Navigators educate them about the CWS process and benefits they are eligible to receive as a resource family. Navigators empower caregivers by teaching them that they have the right to contact the child’s social worker to ask funding questions and can elevate the question to the social worker’s supervisor, and then the manager, if they do not receive a response. If caregivers need assistance, Navigators can contact workers and supervisors on their behalf or with the caregiver to ask the right questions and ensure barriers to disbursement of resource family funds are removed.

For caregivers who are ineligible for or not enrolled in public benefit programs, emergency funds can pay for crucial items such as rent, childcare, or other necessities for the family’s well-being. The data snapshot on page 1 details the amount of emergency funds the program disbursed during the evaluation period as well as the primary expenditure categories.

YMCA Kinship responds to and processes Emergency Fund requests within 24 business hours and receives an average of 26.5 requests per month for an average monthly expense of $20,187. The program maintains partnerships with local vendors to ensure beds and furniture are delivered either the same day or next business day to benefit the family as quickly as possible. Urgency is vital because the longer it takes for a home to be approved through the CWS RFA process, the more time a child could be spending in emergency institutional care or in an unfamiliar foster home. Being removed from their home is a traumatic experience for most children, therefore, our commitment to urgency and removing barriers to rapid placement with relatives is rooted in making every effort to minimize the additional trauma of being placed in unfamiliar institutional care.

Although children in kin care have better well-being outcomes as a result of living with family, their socio-economic status is lowered due to the limited financial support they

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receive. Kinship families in informal arrangements comprise almost half of families served by YMCA Kinship (47%), and they do not qualify for RFA payments (also known as foster care payments) and are only eligible for financial support from the Temporary Assistance for Needy Families (TANF) program, accessible at their local Welfare office. While foster care payments cover 52% of the true cost of raising a child, TANF payments only cover 25% of the true cost of raising one child, or just 17% of the true cost of raising two children.6 Without access to additional financial support, caregivers who are already financially vulnerable risk spiraling deeper into poverty which results in toxic stress and disrupts a child’s optimal development.

Children who engage in extra- curricular activities are more likely to succeed in school and work, avoid engaging in risky behaviors, and increase resilience and selfconfidence in the face of previous adversity.

23% of caregivers rarely or never have extra-curricular activities for the children in their care.

The majority of families in the program have an average annual household income considered below 200% FPL for a family of four.

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Background: According to U.S. Census Bureau data, kinship caregivers are more likely to be poor, single, older in age, less educated and unemployed, compared to families where at least one biological parent is present.

The majority of families in the program have an average annual household income between $12,000 and $35,988, considered below 200% FPL for a family of four. This total results in an income of $1,000-$2,999 per month, compared to an average of $6,333 per month for families with children in San Diego County. These characteristics make it difficult for caregivers to take on any expenses not deemed absolutely essential for the children in their care. Affordable extra-curricular activities can be limited and difficult to find for caregivers already facing multiple constraints on their finances and free time. Further, while the benefits of extra-curricular activities for youth involved in the Child Welfare System are well known, no specific policies exist to encourage or guarantee informal kinship youth participation in extra-curricular activities. As a result many of the children in our program are disconnected from opportunities that would be beneficial to their development.

The Annie E. Casey Foundation (2012), .Stepping Up for Kids: what government and communities should do to support

kinship families.� Baltimore, MD: Retrieved from www.aecf.org.

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Implication: Opportunities for enrichment activities are extremely beneficial for caregivers and the children in their care. Children are able to engage in activities that foster social and individual growth and make friends with peers from different backgrounds. Experiences such as art classes, sports leagues, and day-long or overnight camps, help children develop skills that build confidence, leadership skills, and social aptitudes that lead to success in school and throughout life. Such normative experiences provide a sense of consistency for youth who once faced instability, encourage the growth of relationships that contribute to optimal development, and increase a child’s resilience in the face of adverse experiences and trauma. Children who engage in extra-curricular activities achieve more, avoid engaging in risky behaviors, and develop college and career readiness skills in the face of previous adversity.

Simultaneously, caregivers receive a moment of respite from the emotional and physical toll of raising a child, particularly when the child has been exposed to adverse experiences. According to Harvard’s Center on the Developing Child, the most important factor in helping a child heal from trauma is a stable, loving connection with a caregiver 7 who can help regulate their emotions or behaviors and is able to consistently respond to the child in a reliable and loving manner. However, the stress that results from feeling overwhelmed by their caregiving duties, (i.e., lack of respite, financial, and other resources) undermines the caregiver’s ability to parent in a way that promotes healing.

For grandparents raising grandchildren, respite opportunities that extra-curricular activities provide are also beneficial for their physical health. Raising children can be extremely tiring for grandparents who experience limited mobility, endurance, and strength due to their age, and research has also revealed that caregiving grandparents report lower satisfaction with their health and poorer self-reported health compared to non-caregiving peers.8 When caregivers have access to a brief respite in parenting, they can restore their depleted energy centers and feed their mental and physical health in a way that allows them to parent in a trauma-informed manner, whichs helps promote safety and permanency for the children in their care.

7

National Scientific Council on the Developing Child. (2004). Young children develop in an environment of relationships.

Working Paper No. 1. Retrieved from http://www.developingchild.net 8

Minkler, M., & Fuller-Thomson, E. (1999). The health of grandparents raising grandchildren: results of a national study.

American Journal of Public Health, 89(9), 1384-1389.

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16% of caregivers report they rarely or never have the educational needs of the children in their care met.

Background: Children in kinship care may face a number of circumstances that interfere with the learning process, including organic learning challenges, developmental delays resulting from neglect or infant substance exposure, chronic trauma responses, and complex social-emotional responses resulting from grief and loss of parental separation.

These challenges mirror those of children in non-kin foster care, however, kids in kin care are fortunate to experience significantly fewer placements and, therefore, fewer school changes. Kinship Navigators offer a number of services to make the most of this stability and promote the child’s academic success.

Navigators help caregivers meet the education needs of their children in many ways including: assisting with school enrollment, maintaining open lines of communication with school staff, confirming their rights as the education rights holder, travel reimbursement for travel to school of origin, if applicable, or tutoring resources for when a student is behind in a particular subject.

Kinship Navigators also support families with special education services when a student needs more than just a tutor. Caregivers can participate in an SST (Student Study Team) meeting with school staff to implement a plan to address barriers to the student’s success.

If the student requires additional support, caregivers can request an assessment for an Individualized Education Program (IEP), a written document developed for each public school child who is eligible for special education. An IEP affords a child more support for their academic success, but it also exposes caregivers to another complicated network of unfamiliar processes and regulations.

Kinship Navigators assist caregivers in understanding potential indicators for an IEP assessment, including: • speech, language, handwriting, or other academic delays due to organic learning challenge or issues like drug exposure or neglect in infancy, social-emotional issues, • behavior issues resulting from chronic trauma, • social-emotional challenges, such as anxiety or depression related to trauma, grief and loss from parental separation, • disorganization or impulse control problems that could result from organic ADHD or, more often, trauma and hypervigilance, • poor attendance, particularly in older youth, stemming from lack of motivation because of an organic learning disability or general trauma.

Kinship Navigators help educate caregivers about their right to request the assessment should they suspect a need. Caregivers often also need information about the process of requesting an assessment, which should be done in writing and should include the area of concern, assessment needed, and contact information. Many caregivers are unaware that, by law, the school has to respond to their request within 15 calendar days and complete assessments within 60 calendar days.

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Kinship Navigators attend IEP meetings on occasion and often refer clients to IEP advocates, who assist with the process, attend meetings, and educate caregivers about their rights and what questions to ask. The IEP is also supposed to be reviewed annually to ensure that the plan is meeting the student’s needs and to determine if other supports need to be put in place.

Implication: In addition to understanding how to navigate a complex education system, caregivers must also understand the root cause of a child’s academic struggles, including how trauma or exposure to drugs and alcohol in infancy affect brain development and school performance. The experiences that led to a child being placed in kinship care, including abuse/neglect, parental substance abuse, parental incarceration, or living with someone with a mental illness, are considered Adverse Childhood Experiences, a term coined by researchers in an influential study conducted from 1995 to 1997.

Such circumstances can lead to toxic stress and an over-activation of the child’s stress response system that wears down the body and brain over time and can impact a child’s development and well-being. These experiences and the resulting toxic stress can challenge a child’s ability to thrive in school, and they may need special accommodations to ensure their success. Equipped with this foundational knowledge, caregivers can better understand the need to pursue available services and legal recourse to effectively advocate for the academic well-being of the child in their care.

Children who struggle in school are susceptible to dropping out before graduating from high school9 – a critical milestone that can prevent homelessness and unemployment or underemployment, so a successful academic experience creates pathways to career opportunities that can improve economic mobility and increase socio-economic status for children being raised in Kinship care.

9

Jacob Doll, Jonathan & Eslami, Zohreh & Walters, Lynne. (2013). Understanding Why Students Drop Out of High School, According to Their Own Reports: Are They Pushed or Pulled, or Do They Fall Out? A Comparative Analysis of Seven Nationally Representative Studies. SAGE Open. 1-15. 10.1177/21582440135033834.

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UNSEEN NEEDS The specific issue areas of childcare, public assistance, extra-curricular activities, and educational support pinpoint the scope and nature of concrete needs among families. In addition to these tangible needs, Kinship caregivers often have complex socio-emotional needs that require support to increase family wellbeing that promotes loving, safe, stable developmental relationships where children feel they are physically & emotionally safe.

While it is very important to meet a family’s basic needs, that alone will not guarantee stability, well-being, and optimal functioning in society. Between basic needs and optimal functioning are many intangible needs, discussed in more detail below. This understanding motivated the program to investigate other concerns using the Healthy Families Parenting Inventory (HFPI) and make programmatic changes to address these concerns.

Using the HFPI, the program analyzed how caregivers reported their concerns across five parenting-related domains. The HFPI is a valid and reliable outcome measure that was designed by LeCroy & Milligan Associates, Inc., specifically for use in home visitation programs for children, ages 0-5, being raised by a biological parent to detect individual change related to increasing protective factors to mitigate risks and prevent adverse childhood experiences. The assessment measures a total of nine domains of concern; however, the program only measured five domains consistently across both years.

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Data averages reveal that caregivers ranked the concerns in the following order of importance: 1. Parent/Child Interaction (15.6% of caregivers score indicated an area of need) – The Parent/Child Interaction subscale measures the nature of the interactions and the extent to which the parent and child have interactions that promote healthy relationships and attachment. The circumstances that necessitate a kinship placement, including abuse and/or neglect, substance abuse, and incarceration among biological parents, create a traumatic environment, and disrupt the process of building secure bonds, which can lead to behavioral and physiological symptoms among children. The chronic stress of that trauma can manifest itself in what Child Welfare expert Amelia Franck Meyer calls “pain-based behaviors.” These behaviors can include excessive screaming or crying, impulsive behavior in social situations, lack of self-confidence, aggressive behavior, delayed skill development, and difficulty trusting others, to name a few.

Pain-based behaviors can result from chronic stress from trauma and lack of a secure attachment to a caregiver. Inconsistent or unavailable caregivers disrupt a child’s formation of a secure attachment and cause that child to rely on ineffective emotional regulation strategies. Insecure parental attachment may lead to negative consequences including increased levels of stress hormones, negative views of themselves and others, and poor regulation of emotion and/or behavior.10 Fortunately, a trusted parent/caregiver can help children regulate their strong emotions, prevent overwhelming stress, and increase the child’s ability to effectively communicate what they feel or need. This approach can build resilience in children who have been affected by family fracturing and can reassure them that the adults in their lives are invested in their well-being.11

10

Teach Trauma (2019). Children who are traumatized are at risk for developing complications with attachment. Retrieved from http://www.teachtrauma.com/information-about-trauma/traumas-impact-on-attachment/ 11

Peterson, S. (2018, March 23). How Early Childhood Trauma Is Unique. Retrieved from https://www.nctsn.org/what-ischild-trauma/trauma-types/early-childhood-trauma/effects

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Trauma-informed interventions and parenting promote healing, reduce behavioral challenges, and build bonds between the child and caregiver, yet many caregivers are unfamiliar with how to parent a child that has experienced trauma with nearly half (45%) of caregivers reporting that children in their care are rarely or never receiving professional help to heal from trauma. Understanding that healing occurs through access to such developmental relationships, the program educates caregivers about the root causes and effects of trauma, communicates the importance of relationship for healing, and refers caregivers to parent education classes like SAY San Diego’s Project KEEP and Foster and Kinship Care Education Program at Grossmont College.

2. Personal Care (average 15% of caregivers score indicated an area of need) – The Personal Care subscale determines how much attention caregivers pay to their personal well-being and measures the degree to which the caregiver relates self-care to improved parenting.

Kinship caregivers face complex stressors that impact their well-being: significant financial constraints that lead to poverty when taking in children, grief and shame about adult children who are not being able to care for their own children due to addiction, mental illness, domestic violence, incarceration, etc., setting boundaries with adult children, loss of friends and support systems, disruptions to leisure time and hopes for retirement, parenting children who have experienced trauma, navigating complex systems, facing their own health concerns, or going back to work to support children.

Taking in kinship children is typically an unexpected and life-changing event that upends a caregiver’s previous life plans, and when caregivers prioritize the needs of others before their own, they are susceptible to the symptoms of physical illness and chronic stress. These circumstances can impede a caregiver’s ability to engage in the developmental relationships that help children heal and move beyond trauma.

Self-care, including opportunities for physical activity, a nutritious diet, a calm mind, and restful sleep are critical for any individual to function properly and maintain physical and psychological wellness.12 Parents and caregivers who have the resources to prioritize their own self-care and can identify strategies to manage stress are better prepared to offer their child appropriate care. Caregivers must have access to respite opportunities during which the children in their care receive quality supervision while they engage in activities of their choosing to increase social and emotional well-being and resilience. The program champions personal care among caregivers by educating caregivers about the connection between personal well-being and their ability to bond with the child, encouraging self-care through respite services or other opportunities , offering discounts to YMCA memberships and programs, and suggesting participation in family events and support groups.

12

Harvard Health Blog (2017, November 16) Self-care: 4 ways to nourish body and soul [Blog Post] Retrieved from https://www.health.harvard.edu/blog/self-care-4-ways-nourish-body-soul-2017111612736

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3. Depression (average 14.6% of caregivers score indicated an area of need) – Many factors associated with kinship care, such as unexpectedly raising a child, the challenges faced by the biological parents, the loss of social supports, and the financial struggles, to name a few, can overwhelm caregivers and lead to depression, which can impact the quality of their relationship with the child. The Depression subscale is not intended to diagnose caregivers, but rather to highlight an area that may need further assessment or referrals. When caregivers face their own mental health challenges, their ability to meet the needs of the children in their care is compromised. If left unaddressed, depression in a kin-caregiver’s home destabilizes a sense of psychological safety for the child, jeopardizes the caregiver’s ability to maintain permanency, and raises the possibility of removal, which has a number of adverse effects on children. The program addresses this need by educating caregivers about the importance of their physical and mental well-being, facilitating peer support via support groups, offering respite opportunities, and referring caregivers to mental health services as needed.

4. Social Support (average 13.2% of caregivers score indicated an area of need) – The Social Support subscale measure a caregiver’s sense of connectedness with friends, family, and community along with the extent to which caregivers can identify people or resources to help with challenges, stressors, or other life events that may require support. Many caregivers report intense feelings of isolation after their social circles are upended because peers can no longer relate to their situation.

Further, studies note that grandparents who raise their grandchildren without the support of a spouse have fewer social supports in the caregiving process.13 Support groups that are available to caregivers in easily accessible locations and at convenient times provide a consistent opportunity for caregivers to connect with other adults with shared experiences and receive help from one another in the form of: referrals to childcare or other resources, respite opportunities to practice self-care, and play dates. Supportive relationships establish a sustainable network of natural mentors and build a sense of community among kinship families. The YMCA Kinship Program increases a caregiver’s social supports by educating them about the importance of connecting with caregiving peers, referring them to support groups, and hosting multiple family events to enhance connections among kinship families.

13

Jendrek, M. P. (1994). Grandparents who parent their grandchildren: Circumstances and decisions. The Gerontologist, 34(2), 206-216.

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5. Parent efficacy (average 10.9% of caregivers score indicated an area of need) – Parent efficacy, or how caregivers perceive their ability to parent, ranked last of the five HFPI domains of concern among program participants. Beliefs about one’s effectiveness or efficacy influence the actions one chooses, the types of goals and challenges set, the level of effort made in different endeavors, resilience to adversity, and the quality of their emotional life. Particularly for grandparents raising grandchildren, it is likely at least 15-20 years have passed since they cared for a young child. In that time, parenting practices have changed drastically and are further complicated by the fact that their kin children may have experienced complex trauma. Support groups and other program resources educate caregivers on attachment theory, trauma-informed parenting and positive discipline to ensure the children in their care reach appropriate developmental milestones and are afforded the safe and loving home environment that all children deserve.

The data were largely consistent across the two years, however the domains of social support and parent efficacy ranked as higher areas of concern (6-11%) among caregivers surveyed in the second year compared to those surveyed in the first year.

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SUPPORTIVE SERVICES FOR KINSHIP CAREGIVERS With more than 20 years of experience working with kinship caregivers, the YMCA has fine-tuned an array of services to give caregivers access to the supports necessary to achieve safety, permanency, and well-being for their families. Caregivers can participate in one or more services based on their needs.

NAVIGATION & CASE MANAGEMENT

SUPPORT GROUPS Weekly support groups around the county providing: - Education - Training - Peer support for caregivers - Light meal and childcare

- In-home and telephonic support to caregivers - Assist clients with understanding complicated service agencies, obtaining guardinship, and securing public benefits

FAMILY EVENTS Families in a given region can come together and enjoy a meal and activities with their kinship children and meet other kinship families

YMCA KINSHIP SUPPORT SERVICES

RESPITE CARE

YMCA OF SAN DIEGO COUNTY

A temporary break or rest for caregivers over age 55 (funded by AIS) - Day camp - Overnight camp - Childcare - AM/PM care

- Discounted YMCA memberships - Childcare referrals and subsidies - Access to enrichment programs and overnight and day camps - Familiar and convenient family-focused organizatio

n

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EMERGENCY FUNDING Funds to purchase items and/or services for families: - Beds - Cribs - Pool fences - Rental assistance - Utility assistance

CONCLUSION For children who have experienced trauma, particularly in instances of abuse and neglect, a safe environment and a supportive relationship with a trusted adult caregiver are critical to healing and breaking cycles of dysfunction.

Society expects children in traditional foster care settings to flourish, yet the approach only addresses a subset of a child’s needs and disregards the importance of other elements children need to heal from the trauma of disconnection. Foster care focuses on basic physical safety but fails children by removing them from developmental relationships and the emotional safety, love, and belonging that are hallmarks of a true home. Relative care, instead of traditional foster care, can offer children these exact supports.

Children cannot be raised by systems, they need to be raised by families. The YMCA Kinship program empowers the caregiver by coupling access to the best available resources and knowledge with emotional support to cultivate a healing environment that helps the children in their care increase resilience and thrive. The positive outcomes of relative care on children are evident, but the load on caregivers is significant, so caregivers must have access to a continuum of supportive services. This immediate investment in the caregiver ensures the children in their care have access to the developmental relationships that lead to a healthy, prosperous adulthood.

Suggested Citation Montes, L., Zuñiga, D., Brooks, M., & Straub, K., (2019) Kinship Support Program Summary: Data Analysis and Implications 2016-2018. San Diego: YMCA of San Diego County. © 2019 Project Team - YMCA Youth & Family Services Luisa Montes, Impact Communication Director (lmontes@ymca.org) Danielle Zuñiga, Associate Executive Director, Family Support & Preservation Melissa Brooks, Program Director, YMCA Kinship Kendra Straub, Applied Research Analyst YMCA Kinship Support Program is funded by the County of San Diego Health and Human Services Agency's Child Welfare Services Department.

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APPENDIX Table 1. Primary Reasons for Absence of Biological Parent

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