JANUARY 20, 2014 I S S U E F O C U S Raising Healthy Grandchildren NICOLE DREISBACH, M.P.H., Grantmakers In Health This Issue Focus article is adapted from an October 30, 2013 Grantmakers In Health webinar, which featured Barbara Graves- FIGURE 2: RACIAL/ETHNIC AND AGE DISTRIBUTIONS OF GRANDPARENTS Poller, MFY Legal Services’ Kinship Caregivers Law Project; Jeff RAISING THEIR GRANDCHILDREN, 2011 Kim, The California Wellness Foundation; Angie Schwartz, Alliance for Children’s Rights; Steven Wallace, University of Race/Ethnicity Age California, Los Angeles (UCLA) Center for Health Policy 3% 70+ yrs 30-44 yrs Research; and Pat White, The New York Community Trust. 22% Asian 9% 12% Black I n the United States, more than three million children are 60-69 yrs in the primary care of a grandparent (Livingston 2013). An 20% 25% 51% Latino analysis by the Pew Research Center has helped to sketch a White 45-59 yrs profile of these families. Among the grandchildren, three-in- 54% five are nonwhite, and nearly one-half are under the age of six 4% (Figure 1). Among the grandparents, nearly two-thirds are Another women, one-half are white, and two-thirds are under the age race of 60 (Figure 2). More than one-half (55 percent) of these Source: Livingston 2013 grandparents have been the primary caretaker for three years or more, and they face a number of economic, legal, and health benefits or they receive fewer benefits, placing further challenges (Livingston 2013). financial strains on the family budget (Schwartz 2013). • Economic Challenges: Grandparents often become pri- • Legal Challenges: The majority of caretaker grandparents mary caretakers unexpectedly, assuming added financial are raising their grandchildren without a legal relationship, responsibilities with little outside assistance (Padilla-Frausto such as adoption, custody, or foster care, and many of these et al. 2013). More than one-quarter (28 percent) of children children are found outside the child welfare system (Van who are in the primary care of a grandparent are living Etten 2012). Without this legal relationship, these families below the federal poverty level (FPL)(Livingston 2013). have limited access to public assistance, services, and other National and state policies have not kept pace with chang- supports, and caretaker grandparents may have difficulty ing family structures (Van Etten 2012), and as such, many providing medical and educational consent for their grandparent-headed families are either not eligible for grandchildren (Van Etten 2012). • Health Challenges: Approximately one-quarter (24 per- FIGURE 1: RACIAL/ETHNIC AND AGE DISTRIBUTIONS OF CHILDREN CARED FOR cent) of caretaker grandparents have some type of disability PRIMARILY BY A GRANDPARENT, 2011 (Livingston 2013). Caretaker grandparents also have been found to experience increased psychological distress and a Race/Ethnicity Age 3% diminished quality of life (Kelley et al. 2013; Musil et al. Asian 2013). Less research is available about the grandchildren. 26% 20% There is evidence, however, that they are likely to exhibit Black 13+ yrs signs of behavioral or mental health problems (Campbell et 45% 25% Less than al. 2012), as some children are coming into the care of a Latino 6 yrs grandparent because of stressful family circumstances and 39% 35% trauma (Smith et al. 2007). White 6-12 yrs PHILANTHROPIC ACTIVITIES 7% Another race A number of health funders are investing in efforts to meet the Source: Livingston 2013 economic, legal, and health needs of grandparents who find themselves as the primary caretaker of their grandchildren. I S S U E F O C U S GIH BULLETIN ® Addressing Economic Security – The California Wellness ® Creating Linkages to Health, Counseling, and Peer- Foundation (TCWF) approaches this issue through the lens Support Services – A handful of grantmakers serving the of two of their health priorities: healthy aging and the men- Greater Philadelphia region have joined together to fund the tal health of homeless and transition-age youth (Kim 2013). GrandFamily Resource Center, a program at the nonprofit Through this dual lens, TCWF has been identifying the agency Supportive Older Women’s Network. The economic insecurities of the elderly, including caretaker GrandFamily Resource Center is designed to keep vulnera- grandparents, as well as addressing the needs of transition- ble families intact by supporting both caretaker grandparents age youth who age out of the foster care system. Since 2007 and their grandchildren. The program provides a “one-stop” the foundation has been investing in research and analysis of approach by linking grandparents and their grandchildren to elder economic security, and most recently funded The High educational, health, and referral services. Additionally, the Cost of Caring: Grandparents Raising Grandchildren. This program provides grandparents with case management, health policy brief, jointly produced by the UCLA Center individual counseling, and peer support groups, either for Health Policy Research and the Insight Center for community-based or telephone-based, for those who are Community Economic Development, details at a county homebound. The program was originally funded by the level the economic insecurities faced by many of California’s Robert Wood Johnson Foundation’s Local Funding elderly caretaker grandparents (Padilla-Frausto et al. 2013.) Partnerships matching grants program, along with grants The analysis used the Elder Economic Security Standard from the William Penn Foundation, Samuel S. Fels Fund, Index, which provides a more accurate estimate of the cost The Philadelphia Foundation, The Allen Hilles Fund, The of living than the FPL and is based on county-level prices for Douty Foundation, The Fourjay Foundation, the Claneil medical care, housing, transportation, and food, among Foundation, and the Connelly Foundation, as well as some other items. A key finding was that elderly caretaker grand- local agencies. The matching grant program has now ended, parents would need incomes approximately twice that set by and the Connelly Foundation has continued funding the the FPL in order to support a basic standard of living for GrandFamily Resource Center as part of its health and themselves and their grandchildren (Padilla-Frausto et al. human services portfolio. 2013). The report’s recommendations include prioritizing low-income elderly caretaker grandparents to receive afford- ADDITIONAL OPPORTUNITIES FOR able housing and subsidies, increasing Supplemental HEALTH FUNDERS Nutrition Assistance Program income eligibility criteria to Whether they assume this role for months or years, caretaker 200 percent of the FPL, and improving access to mental grandparents and their grandchildren can benefit from tailored health services in community or school settings. services, supports, and policies that meet their needs. In addi- ® Supporting Advocacy Efforts and Legal Services – The tion to activities like the ones described above, health funders New York Community Trust has approached kinship care, might also consider: and more specifically the role of caretaker grandparents, ® Directly Addressing the Health and Wellness Needs of through three program areas: social services and welfare, Children and Youth in Their Grandparents’ Care – aging, and youth development (White 2013). Over the years Children often come into the care of a grandparent because the trust has worked across these program areas to fund of stressful family circumstances and trauma. To meet these advocacy efforts that recognize kinship care as an option for needs, funding could be directed toward efforts such as children entering or leaving the foster care system, research expanding graduate and continuing education training in efforts to better understand the needs of caretaker grandpar- trauma-informed care for professionals so that they are bet- ents and inform practice and policy changes, and support ter prepared and equipped to identify and serve the needs of agencies that serve grandparents or youth (White 2013). In children and families, and improving linkages between addition, for several years the trust has funded MFY Legal children, youth, and families and direct services to meet Services, and more specifically its Kinship Caregiver Law their legal, financial, and health needs (White 2013). Project, to meet the legal needs of caretaker grandparents. MFY Legal Services was created to provide free legal assis- ® Supporting Research, Analysis, and Policy Efforts – tance to low-income and underserved New York City Funding further research and analysis could assist in devel- residents. The Kinship Caregiver Law Project provides oping a better understanding of the health and wellness caretaker grandparents with much needed assistance in needs of children and youth who enter grandparent care and navigating the legal system in cases of adoption, custody and a better understanding of the effects of grandparent care on guardianship, visitation, kinship foster parents, and immi- children’s health and development, especially given that grant juvenile status, as well as assistance with public many children in grandparent care are younger and receive benefits and community resources (Graves-Poller 2013). care for an extended period of time. State and national More recently the trust has awarded funding to expand legal policy strategies could assist in reducing the inequities advice and representation for grandparents and other experienced among grandparent-headed families, including relatives who are caring for children. those related to housing, food, and health (Kim 2013). I S S U E F O C U S GIH BULLETIN SOURCES Campbell, Lenora, Dana Carthron, Margaret Shandor Miles, and LaShanda Brown, “Examining the Effectiveness of Case Management Programs for Custodial Grandparent Families,” Nursing Research and Practice, 2012. Graves-Poller, Barbara, remarks at the Grantmakers In Health Webinar, Grandparents Raising Grandchildren, October 30, 2013. Kelley, S.J., D.M. Whitley, and P.E. Campos, “Psychological Distress in African American Grandmothers Raising Grandchildren: The Contribution of Child Behavior Problems, Physical Health, and Family Resources,” Research in Nursing and Health, 36(4):373-385, 2013. Kim, Jeffrey, remarks at the Grantmakers In Health Webinar, Grandparents Raising Grandchildren, October 30, 2013. Livingston, Gretchen, “At Grandmother’s House We Stay,” Pew Research Center, <http://www.pewsocialtrends.org/files/2013/09/grandparents_report_final_2013.pdf>, 2013. Musil, Carol M., Jeanblanc, Alexandra B., Burant, Christopher J., Zauszniewski, Jaclene A., and Warner, Camille B., “Longitudinal Analysis of Resourcefulness, Family Strain, and Depressive Symptoms in Grandmother Caregivers,” Nursing Outlook 61(4):225-234, e.2, 2013. Padilla-Frausto, D. Imelda, and Steven P. Wallace, The High Cost of Caring: Grandparents Raising Grandchildren, UCLA Center for Health Policy Research and Insight Center for Community Economic Development, <http://healthpolicy.ucla.edu/publications/Documents/PDF/ grandparentspb-jun2013.pdf>, June 2013. Schwartz, Angie, remarks at the Grantmakers In Health Webinar, Grandparents Raising Grandchildren, October 30, 2013. Smith, Gregory C., and Patrick A. Palmieri, “Risk of Psychological Difficulties Among Children Raised by Custodial Grandparents,”Psychiatric Services 58(10):1303-1310, 2007. Van Etten, D., and R. Gautam, “Custodial Grandparents Raising Grandchildren: Lack of Legal Relationship is a Barrier for Services,” Journal of Gerontological Nursing 38(6):18-22, 2012. White, Patricia, remarks at the Grantmakers In Health Webinar, Grandparents Raising Grandchildren, October 30, 2013.