RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
According to the U.S. Census Bureau, in 1999 more than 3.9 million children in America were being raised in homes maintained by one or more grandparent. Census 2000 data revealed that only about 6.4 percent of these children (250,000) had the benefit of the services and support that public agencies offer foster parents.
The Edgewood Center for Children and Families is a neighborhood family assistance and health center in San Francisco. In 1995, Edgewood created a "Kinship Support Network," a public/private collaboration to fill the gaps in public social services for kin caregivers grandparents and other relatives who were caregivers and the children for whom they cared. In 1997, the California legislature enacted a measure (AB 1193) to replicate Edgewood's kinship support network model in other California counties with many dependent children placed with kin caregivers. Seventeen counties qualified.
Through a grant that same year, Edgewood added a health team to its kinship support network services. When funding for the health team ended in 2000, the Robert Wood Johnson Foundation (RWJF) provided an unsolicited grant for Edgewood to reestablish the health team and help create comparable health teams in the 17 counties.
Questionnaires administered by project staff to 126 kin caregivers at Edgewood in 20012004 revealed the following:
RWJF provided a grant of $1,099,549 from February 2001 to October 2004.
The U.S. Census Bureau released figures in May 1999 showing that more than 3.9 million children nationally were being raised in homes maintained by one or more grandparent, with or without a parent present. Census 2000 data showed only 500,000 of these children to be in the child welfare system, with about half of these in kinship placement.
Only about 6.4 percent of children being raised by grandparents (or 250,000) had access to the kinds of financial resources, services and support that public agencies offer foster parents. In these homes, because of the age of the caregiver, it was and is often the case that both caregivers and children required significant health care.
The Edgewood Center for Children and Families is a neighborhood family assistance and health center serving a minority population along San Francisco's inner harbor. In 1993, Doriane Miller, M.D., established "Grandparents Who Care" at Edgewood, a project to help kinship homes.
In 1995, Edgewood expanded that project to form the more comprehensive "Kinship Support Network," a public-private collaboration intended to fill the gaps in public social services for relatives who were caregivers and their children as an alternative to foster care. It provided social work case management and support services (such as peer mentoring, parenting education and respite care) and home visiting by trained paraprofessionals from the local community. To support this sort of work, in 1997, RWJF funded a conference on kinship parenting sponsored by Edgewood (see Grant Results on ID# 030761).
In 1997, the California legislature enacted a measure (AB 1193) to replicate Edgewood's kinship support network model in all California counties with more than 40 percent of dependent children placed with kin caregivers. Some 17 counties qualified.
Under the bill, the social services agency of each eligible county received funding as an incentive to develop services in partnership with local nonprofits administering a kinship support network. The bill also provided limited funding for Edgewood to deliver technical assistance to participating counties and/or their participating nonprofit partners. In that year, Edgewood added a health team to its own kinship services with funding from the National Center for Child Abuse and Neglect.
When this grant ended in 2000, Edgewood sought grant funding from RWJF to recreate its health team and to help establish comparable health teams in counties in which it was working and in new counties eligible for kinship support network incentives under AB 1193. By the end of 2000, 20 such projects had been launched in 10 California counties Alameda, Contra Costa, Los Angeles, Monterey, Riverside, San Diego, San Francisco, San Mateo, Santa Clara and Stanislaus.
Project staff envisioned the establishment of an additional 20 projects during 2001. Each project represented at least the potential for a health team serving kin caregivers and their children already participating in a kinship support network.
Beginning in February 2001, Edgewood staff planned the following three steps, to be implemented over 45 months:
Project staff did not fully carry out step three of this implementation plan. See Risks and Difficulties for the reasons for this.
See Results for accomplishments at the Edgewood center and limited accomplishments elsewhere. See Findings for data gathered by the health team at the Edgewood project in San Francisco profiling the health and support needs of participating kin caregivers and the health of their children.
In reports to RWJF, project staff cited a number of barriers to their attempts to replicate health teams in other eligible California counties (steps two and three).
In December 2000, Don Cohon, director of Edgewood's research institute, wrote in the grant proposal to RWJF that establishing health teams at new kinship support networks in other counties carried the risk that individuals managing these networks (from county social service agencies and/or the networks' parenting nonprofit organizations) might provide only limited cooperation. According to Cohon, these people were quite focused on putting basic case-management services in place.
Cohon posited three other difficulties:
In October 2002, in an interim report to RWJF, project staff reported the development of an operating health team attached to the kinship support network in San Mateo county (with Edgewood serving as the contractor) and agreement by 12 other counties with existing or planned kinship support networks to participate in health team development. However, in October 2003, staff reported that all counties except for San Mateo "are experiencing significant barriers in implementing new health services."
In October 2004, when the project concluded, in addition to Edgewood, only San Mateo had a functioning health team. In a final project report to RWJF, project staff cited the difficulty of supporting county social service agencies and their nonprofit partners in developing health teams "without being able to offer them concrete financial assistance."
They noted that counties' social service agencies were constrained by budgetary uncertainty and by actual financial shortfalls during the grant period (October 2001 through October 2004): "The budget situation in California is difficult and many of these agencies report working hard just to stay afloat and are unable to focus on developing new services. Indeed, two of the existing kinship support networks that were providing the services of a public health nurse to clients have folded," said the final report to RWJF.
Staff also cited the political climate: "Support for these services is quite limited, especially in the post 9-11 and Iraq war period that has many state and federal agencies focused on anti-terrorist agendas rather than such supportive and preventive services. The California Department of Social Services cut Edgewood's funding to deliver technical assistance to [the underlying] Kinship Support Networks during a significant portion of the grant period. While these funds were eventually reinstated, this did result in an inconsistent ability to travel to [counties operating or considering kinship support networks] to work face to face with staff to develop health services."
During the RWJF grant period, the California Endowment (a private foundation supporting community-based efforts to improve health throughout California) provided $659,000 for the reestablishment of Edgewood's health team and its dissemination and replication work at other projects.
The McKesson Foundation, a program of the McKesson Company, San Francisco, purchased a van for the Edgewood health team to use in transporting caregivers to doctors and workshops.
The First Five California, through its Children and Families Commission, contributed $5,000 in 2004 to fund a physical fitness program run by caregivers at Edgewood. (The commission administers grants generated through California's Proposition 10 tobacco tax.)
The Zellerbach Family Foundation in 20032004 helped fund attendance by project staff at a Stanford University chronic disease self-management program.
The project team reported the following results to RWJF:
Project staff administered health questionnaires to kin caregivers when they entered the HealthyKin project at Edgewood and to many of them after 12 months or sooner if the caregiver left the program or was referred elsewhere.
Some 126 adults caring for 238 children completed most questionnaires between February 1, 2001, and August 30, 2004. For details on the questionnaires, see the Appendix. In a report to RWJF in 2004, researchers described their findings. They also presented some of them at regional or national conferences during 2002 and 2003:
In a 2004 report to RWJF, researchers note: "The picture that emerges from these data are of families in which children are profoundly affecting their older relative caregivers, whose self-reported health is poor when compared to national norms. "
As of November 2005, the HealthyKin program operated at a reduced level with funding for staff provided in part by a $150,000 grant from the California Wellness Foundation, a private foundation. The project no longer employed a full-time nurse practitioner, but continued to benefit from a clinical rotation for nurse interns from San Francisco State University. It offered regular workshops in nutrition and other relevant topics such as depression and chronic illness.
Through a contract with Medi-Cal (California's Medicaid program), HealthyKin provided ongoing mental health services to adults and children. Grant support totaling $25,000 for HealthyKin was pending from Pacificare, McKesson and Kraft Foods. Staff continued to mentor staff of other kinship projects by telephone and e-mail and to supervise a nurse and therapist in San Mateo County.
Developing Health Teams for the Kinship Support Network
Edgewood Center for Children and Families (San Francisco, CA)
Ken Epstein, M.S.W.
Questionnaires Given to the Project's Kin Caregivers
Staff of the Kinship Support Network at the Edgewood Center administered these three questionnaires to adult caregivers when they began to receive services from its HealthyKin project and 12 months later:
Doriane Miller, M.D. In 1993, RWJF named her a Community Health Leader for this work. See www.communityhealthleaders.org for a description of the Robert Wood Johnson Foundation Community Health Leaders Program. Or see the Grant Results on the program. Miller later became a senior program officer at RWJF.
Socio-economic support. An example of a socio-economic support for a caregiver is someone to talk to or protection from neighborhood violence; tangible support would include help budgeting money, getting enough food or having access to a telephone.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Youngblood D. HealthyKin: A Health Resource Manual for Kinship Support Services Programs. San Francisco: Edgewood Center for Children and Families, 2003.
Report prepared by: Nanci Healy
Reviewed by: James Wood
Reviewed by: Molly McKaughan
Program Officer: Paul Jellinek
RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
Learn how The Robert Wood Johnson Foundation is dedicated to building a culture of health in Risa Lavizzo-Mourey's 2014 annual message.
The County Health Rankings & Roadmaps can be put to use right away to help create a culture of health in your community.
RWJF Nurse Faculty Scholar Jennifer Bellot writes about losing her grandmother to complications from a medical error.
America is not getting good value for its health care dollar. These resources explore issues of cost and value of health care.
Judith Halstead, president of the National League for Nursing, writes about the role of nursing education in realizing a transformed health ...
RWJF Health & Society Scholar Brendan Saloner on subsidized health insurance's impact on family economics.
Hilary Levey Friedman, author of Playing to Win: Raising Children in a Competitive Culture, writes about youth sports.
Developing small community homes as alternatives to nursing homes, this radical, new national model for skilled nursing care returns control...
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
The Health and Medical Care Archives at the University of Michigan's Inter-University Consortium for Political and Social Research is the of...
One doctor in Camden, NJ, Jeffrey Brenner, used data to map “hot spots” of health care high-utilizers—one patient had gone to the hospital 1...