Supporting Grandparents Raising 

Grandchildren (SGRG) Act 

Initial Report to Congress

Prepared by: Advisory Council to Support Grandparents Raising Grandchildren

With assistance from: Administration for Community Living,

an operating division of the U.S. Department of Health and Human Services

Support Educate Advocate Empower

November 16, 2021
Contents

The Advisory Council to Support Grandparents Raising Grandchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Federal Representation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Letter from the Principal Deputy Administrator of the Administration for Community Living . . . . . . . . . .  ii

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Important Note on Terminology Used in this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  v

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What Causes Kinship Families and Grandfamilies to Form? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Prevalence of Kinship Families and Grandfamilies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

“Inside” and “Outside” the System (...and Why This Matters) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Why Kinship Families and Grandfamilies Need Recognition and Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Spotlight on the Impact of the Opioid Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Strengths and Benefits of Kinship Families and Grandfamilies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

II. Passage of the Supporting Grandparents Raising Grandchildren Act . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Advisory Council to Support Grandparents Raising Grandchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Mission of the Advisory Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Vision Statement and Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

III. Understanding the Unique Needs of Kinship Families and Grandfamilies . . . . . . . . . . . . . . . . . . . . . . 23

Overview of the Existing Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

The ACL Request for Information about Kinship Families and Grandfamilies . . . . . . . . . . . . . . . . . . . . . . . . . 28

IV. Discussion of Challenges and Systemic Gaps Identified in the RFI . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Financial Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Legal Concerns and Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Education (including Special Education) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Grief, Trauma, and Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Child Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Food and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Respite Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Physical and Mental Health and Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Emergencies and Unplanned Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

V. Supporting Kinship Caregivers in Indian Country: Lessons from the ACL Title VI Programs . . . . . . . . 55

VI. Services and Supports Currently Available to Assist Kinship Families and Grandfamilies . . . . . . . . . 61

Best Practices and Evidence-Informed Supports to Assist Kin and Grandparent Caregivers . . . . . . . . . . . . . . 62

VII. Recommendations: What Kinship Families and Grandfamilies Need to Thrive . . . . . . . . . . . . . . . . . . 74

Priority Area 1: Awareness of/Outreach to Kin and Grandparent Caregivers . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Priority Area 2: Kin and Grandparent Caregiver Engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Priority Area 3: Services and Supports for Kinship Families and Grandfamilies . . . . . . . . . . . . . . . . . . . . . . . . 77

Priority Area 4: Financial and Workplace Security for Kin and Grandparent Caregivers . . . . . . . . . . . . . . . . . . 80

Priority Area 5: Research, Data, and Evidence-Supported Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

VIII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Works Cited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page i

The Advisory Council to Support Grandparents Raising 

Grandchildren

With the passage of the Supporting Grandparents Raising Grandchildren (SGRG) Act in 

July 2018, Congress authorized the establishment of a council (the Advisory Council) 

to support grandparents and other kin caregivers who are raising children, including 

grandchildren. The charge was to identify, promote, coordinate, and disseminate

information, resources, and the best practices available to help grandparents and 

other older relatives meet the needs of the children in their care while maintaining their 

own physical and mental health and emotional well-being

The report that follows outlines progress of the Advisory Council to date and proposes 

22 recommendations for changes to formal and informal systems that will benefit 

grandparents and other kin caregivers of children who cannot remain in the homes 

of their parents. The Advisory Council is composed of grandparents, professionals

working in the field of supports and services to grandparents and the children they 

care for, and representatives of the federal agencies that serve these populations

Advisory Council Appointees

The following 13 non-federal appointees are grandparents, advocates, educators, and 

child welfare professionals. Their biographies are available on the Advisory Council to

Support Grandparents Raising Grandchildren website

■ Jaia Peterson Lent, Advisory Council co-chair and deputy executive director of 

Generations United

■ Ethlyn McQueen-Gibson, D.N.P., M.S.N., R.N.-B.C., Advisory Council co-

associate professor and director of Gerontology Center of Excellence at Hampton 

University
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page ii

■ Martha R. Crowther, M.P.H., Ph.D., associate dean for research at the Universi

Alabama, College of Community Health Sciences

■ Patrick Donavan, supervisor with Muskingum County (Ohio) Adult and Child 

Protective Services

■ Gail Engel, grandparent and founder of Grand Family Coalition

■ Sarah Hedden, B.S., M.S.W., J.D., attorney with the Kinship Care Legal Se

Program at the Center for Elder Law & Justice in Buffalo, New York

■ Bette Hoxie, former director of Adoptive and Foster Families of Maine, Inc. & the

Kinship Program

■ Toni Kleckley, M.A., D.Th., grandparent and founder and executive director

Trans4mation Now Inc., and the Grandparents Educating Minds progra

■ Yvonne S. Lee, M.S.W., professor at West Virginia State Univer

■ Linda Miller, R.N., director of the Iowa Department on Agi

■ Sharon Olson, grandparent and past president of the Minnesota Kinship Caregivers 

Association

■ Sarah L. Smalls, grandparent and family resource coordinator for Formed Families

Forward

■ Charlotte Stephenson, grandparent and advocate

Federal Representation 

The SGRG Act specifically called for participation from the Secretaries (or their 

designees) of the U.S. Department of Health and Human Services (HHS) and th

Department of Education (ED). It also called for participation from the Administrator of

the Administration for Community Living (ACL), the Director of the Centers for Disease 

Control and Prevention (CDC), and the Assistant Secretary for the Administration for 

Children & Families (ACF), all within HHS. In addition to those agencies named in the

SGRG Act, federal representation on the Advisory Council includes participation from:

■ AmeriCorps

■ The Consumer Financial Protection Bureau (CFPB)

■ The Health Resources and Services Administration (HRSA)

■ The National Institute on Aging (NIA), National Institutes of Health (NIH)

■ The Office of the Assistant Secretary for Planning and Evaluation (ASPE)

■ The Office of the National Coordinator for Health Information Technology (ONC)

■ The Substance Abuse and Mental Health Services Administration (SAMHSA)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page iii

Letter from the Principal Deputy Administrator of the 

Administration for Community Living (ACL)

There are more than 2.7 million American children being raised within the loving

homes of kin and grandparent caregivers (U.S. Census Bureau, 2019). These kin

of families are called kinship families or grandfamilies. Even though they are not a

new phenomenon, they are growing increasingly common across the nation. While

each family is different, one characteristic they all share is the presence of a kin or 

grandparent caregiver who is providing support, love, and stability to vulnerable 

children—often outside the child welfare system

These new families form in response to a range of challenges, such as the opioid 

epidemic, death, incarceration, serious mental illness, or other causes. When parents

can no longer care for their children, there is no one better suited to step in than 

grandparents, extended family, and close “family-like” friends—in other words, the 

people whom the children already know and love. But providing that care can come at

a cost to the caregivers’ own physical, mental, and financial health and well-being

The Congressionally mandated Advisory Council to Support Grandparents Raising 

Grandchildren (the Advisory Council) spent two years understanding how to better 

support kinship families and grandfamilies. Even though they are professionals working

in the child advocacy field and grandparents raising children themselves, they talked to 

the experts and they listened to focus groups. They also launched a formal Request for

Information (RFI) that yielded over 1,900 comments from more than 300 respondents 

across the nation. Prominent among these responses was a trove of moving testimonials

from kin and grandparent caregivers about their day-to-day troubles and triumphs

As this report makes clear, the Advisory Council overwhelmingly heard that the legal 

and child welfare systems in this nation are not designed to address the needs of 

these families. Nor are the caregivers adequately supported by federal, state, and local

policies. As a result, many lack access to basic supports and services. They struggl

to house, feed, and clothe themselves and the children in their care. Almost half of

the children living in “grandmother-only” households live in poverty, and Black, African 

American, and Native American communities are over-represented in these families

For many families, the disproportionate inequities they are already grappling with 

each day are only compounded as they navigate complex legal systems, a maze of 

disconnected financial and social services, and social stigma. The ongoing COVID-19

pandemic has exacerbated these challenges, creating new urgency and momentum to 

address the needs of kinship families and grandfamilies

These unmet needs go straight to the heart of ACL’s mission. Forty percent of kin

and grandparent caregivers are older adults, and 25% have disabilities (U.S. Censu

Bureau, 2019). Often, they are caring for children who experience disabilities. ACL i
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page iv

committed to advancing programs and policies that support opportunities for older 

adults and people with disabilities of all ages to thrive in their own communities. The

President’s American Rescue Plan, signed into law in March 2021, directed ACL to 

establish the nation’s first National Technical Assistance Center on Grandfamilies and 

Kinship Families. This effort directly aligns with the mission of the Advisory Counci

The needs of caregivers of all types are at the forefront of public policy, including 

the priorities of the Biden-Harris Administration. The President’s Build Back Better

Plan calls for significantly increased funding for accessible child care and preschool, 

nutrition and housing assistance, and supports for caregivers, including family 

caregivers—all of which have the potential to transform the lives of many kinship 

families and grandfamilies. Together, these investments, along with the National Family

Caregiving Strategy being created pursuant to the Recognize, Assist, Include, Support, 

and Engage (RAISE) Family Caregivers Act and to be released in early 2022, will 

transform how the nation supports a population of caregivers, who—until now—have 

received little in the way of appreciation and recognition for their selfless contributions 

to the well-being of generations of children

With the release of this groundbreaking report, we now have an unprecedented 

opportunity to achieve—and go far beyond—the goals Congress mandated in the 

Supporting Grandparents Raising Grandchildren Act. I want to express our deepest

gratitude to the members of the Advisory Council for their hard work on this report. As

this report shows, we have our work ahead of us if we are to truly support the millions 

of kin and grandparent caregivers in the United States of America. We have a unique

opportunity to bring that vision to life, and we are committed to seizing it

Alison Barkoff 

Principal Deputy Administrator

Administration for Community Living

U.S. Dept. of Health & Human Servi
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page v

Acknowledgements

This report would not have been possible without the generous support, assistance, 

expertise, and advocacy of a wide range of stakeholders committed to assisting the 

millions of kin and grandparent caregivers across the nation who step in to care for 

children who cannot remain with their birth parents

Many voices came together in the development of this document. Notably, the

members of the Advisory Council, with assistance from ACL, shaped this document 

from inception to outline through discussion and review. The Advisory Council

appointees shared key insights gleaned from years of experience raising grandchildren 

and working in the child welfare and advocacy fields. In addition, a working group of

members drafted text for the rationale statements that support each of the Advisory 

Council’s recommendations below. The Advisory Council also wishes to extend its

appreciation to Charlotte Stephenson for her dedication in reviewing and vetting 

resources submitted through the RFI into the needs and challenges of kinship families 

and grandfamilies

In addition, representatives from multiple federal agencies served on the Advisory 

Council and contributed expertise and insight to the Advisory Council discussions. The

value of this became especially evident as the Advisory Council explored the feasibility 

of its proposed recommendations and during clearance of the document. Federal

members also provided valuable information on existing programs and resources in the 

federal government to support grandparents raising grandchildren

The Advisory Council recognizes the hundreds of members of the public and 

representatives of advocacy groups who responded to the RFI. Many of the comments

received were deeply personal and served as a constant reminder to the Advisory 

Council of the urgency to develop practical solutions to address the needs of kinship 

families and grandfamilies. Approximately 50 of those comments are included in

this report. Also included are key comments from members of the Advisory Counci

Multiple subject matter experts within ACL provided critical input and guidance on this 

report, including the ACL regional administrators, ACL grantees, and staff within ACL’s 

Office of American Indian, Alaskan Native, and Native Hawaiian Programs (Title VI) and 

the Center for Policy and Evaluation

Finally, it is important to note that this report is the result of many years of effort by 

a wide range of stakeholders and other advocates. The passage of the SGRG Act

was the result of years of dedicated advocacy on the part of grandparents and other 

kin caregivers and organizations including Generations United, the American Bar 

Association Center on Children and the Law, Annie E. Casey Foundation, Casey Family

Programs, the Children’s Defense Fund, and the American Academy of Pediatrics

Without these advocacy groups and the tireless work of legions of family members, 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page vi

social workers, child welfare professionals, and community organizations, this critical 

report and its recommendations would not have been possible

Important Note on Terminology Used in this Report

The Advisory Council recognizes that federal and state legislation, the child welfare 

system, and state and local jurisdictions use a variety of terms to describe the 

families that are the focus of this report. These terms include fictive kin, kin, kinship

caregivers, families of choice, person acting as a parent, non-parent caregiver, 

person acting in a parental relationship, etc. Similarly, inconsistencies exist among

other aspects of the nomenclature related to kinship families and grandfamilies. For the

purposes of this report, the Advisory Council agreed on the following terms:

■ Adverse childhood experiences (ACEs): Many kinship families and grandfamilies 

come together in response to violence, abuse, neglect, disasters, death, substance 

use disorders, or other emotionally harmful experiences. When the experiences

occur during childhood, they are known as adverse childhood experiences (ACEs)

Research has found that although most children exposed to ACEs are resilient, a 

significant minority of children exposed may go on to experience chronic health 

problems, mental illness, and substance use problems in adulthood. ACEs

can also negatively impact education, job opportunities, earning potential, and 

longevity. Notably, research “suggests that the impact of these adverse childhood

experiences on adult health status is strong and cumulative” (Felitti, et al., 1998

■ Child welfare system: This report uses this term defined by the Children’s Bureau 

within the U.S. Department of Health and Human Services as “a group of service

designed to promote the well-being of children by ensuring safety, achieving 

permanency, and strengthening families.” The primary responsibility for child 

welfare services rests with the states, however, the federal government supports 

states through program funding and legislative initiatives (Child Welfare Information 

Gateway, 2020)

■ Note: Within this report, for the purposes of expediency, the Advisory Council 

uses the term “inside the system” to describe families with children who have been 

placed in the child welfare system, usually known as “formal” families (Child Welfare 

Information Gateway, 2020). The term “outside the system” is used here to describe

families with children who are not in the child welfare system, also sometimes 

known as “informal” families

1

■ Grandchildren and/or children: Throughout this report, these terms describe 

the care recipients in kinship families and grandfamilies. This term applies to minor

children and adult children with disabilities whose primary caregivers are kin and 

grandparents. The Advisory Council uses these terms for expediency, recognizing
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page vii

and acknowledging that some care recipients in these families are nieces, nephews, 

great-grandchildren, godchildren, siblings, cousins, and/or beloved family friends

■ Kin and grandparent caregivers: The Advisory Council uses this term when it is 

necessary to specify the adults who have primary responsibility for grandchildren or 

other children who cannot remain with their parents

■ Kinship families and grandfamilies: To signal support for the diversity of families 

raising grandchildren today, the Advisory Council adopted the widest possible 

definition for the families who step up to raise children who are unable to reside 

with their parents. Typically, “kinship family” refers to families where individuals are

related by heredity, marriage, friendship, or adoption. The term “grandfamilies” is

a type of kinship family where children live with grandparents or other adults with 

whom they have a family-like relationship. The Advisory Council uses “kinship

families and grandfamilies” as an inclusive term in this report to describe all 

members of the blended and extended families raising grandchildren, godchildren, 

nieces, nephews, siblings, and dear family friends. This term includes families in

caregiving arrangements such as when a child is placed with a state’s child welfare 

system, those in which a child is placed in the custody of the caregiver by child 

welfare authorities, and those families who have taken responsibility of rearing 

children outside the child welfare system

■ Trauma-informed care: As a result of exposure to some type of trauma or traumatic 

event, both children and adults may need interventions grounded in the knowledge 

and understanding of trauma and its implications. This report uses a definition

developed by the Substance Abuse and Mental Health Services Administration’s 

(SAMHSA) Trauma and Justice Strategic Initiative to define trauma-informed care: 

“A program, organization, or system that is trauma-informed realizes the widespread 

impact of trauma and understands potential paths for recovery; recognizes the 

signs and symptoms of trauma in clients, families, staff, and others involved with 

the system; and responds by fully integrating knowledge about trauma into policies, 

procedures, and practices, and seeks to actively resist re-traumatization” (Substance 

Abuse and Mental Health Services Administration, 2014)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 1

Executive Summary

“Grandparents and relatives are amazingly resilient and strong members 

of our community, they are often overlooked, but from my years of 

experience in social work, this is THE group that can help 

transform child permanency in our communities.”

-Response to 2019 RFI about the needs and priorities of kinship families and grandfamilies.

Families are the central and enduring influence in children’s lives, shaping their 

development, identity, values, and sense of security (Schor, Edward; American 

Academic of Pediatrics Task Force on the Family, 2003). Throughout history and

across cultures, grandparents have been at the heart of this experience. They are a

recognized source of wisdom, practical assistance, and unconditional love for children

They nurture family connections and foster cultural identity while providing trusted 

practical support to parents and children alike

When tragedy strikes and parents can no longer care for their children—whether due 

to the opioid epidemic, death, incarceration, serious mental illness, or other causes—

there is no one better suited to step in and raise the children than grandparents, 

extended family members, and close family friends. Unlike the caregivers and providers

in traditional foster homes and institutional settings, kin and grandparent caregivers 

already know and love the children, they understand the losses and grief the children 

face, and, as a result, are better suited to help them continue to grow and learn within 

the warm embrace of a loving family

Collectively, known as “kinship families or grandfamilies,” these families are not a 

recent phenomenon. Throughout history and across cultures, grandparents—especially

grandmothers—have stepped in to raise children (Minkler & Fuller-Thompson, 2005)

The difference now is that the need for loving support of children is growing. The

number of children who cannot live with their parents continues to increase across the 

nation. In drafting the Supporting Grandparents Raising Grandchildren (SGRG) Act,

Congress found that “between 2009 and 2016, the incidence of parental alcohol or 

other drug use as a contributing factor for children’s out-of-home placement rose from 

25.4 to 37.4 percent” (The Supporting Grandparents Raising Grandchildren Act, 201

Against the backdrop of that increase, millions of grandparents, relatives, and close 

family friends are stepping up to raise children who cannot remain with their parents 

for other reasons, such as deployment, death, incarceration, and economic adversity

These caregivers are making tremendous sacrifices to care for and protect the 

vulnerable children they love outside the formal systems designed to care for children, 

and largely on their own. In doing this without support, they incur significant personal

and financial costs and put their physical and mental health at risk, since there are few 

supports and services in place designed to assist these families
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 2

Congress established The Advisory Council to Support Grandparents Raising 

Grandchildren (SGRG) (the Advisory Council) to address these critical and intertwined 

issues. Congress charged the Advisory Council with identifying, promoting,

coordinating, and disseminating information, resources, and best practices to help 

grandparents and “older relative caregivers” of children meet the health, educational, 

nutritional, and other needs of the children in their care, while at the same time 

maintaining their own physical, mental, and emotional health and well-being. This

vision includes all kinship families and grandfamilies, regardless of whether they 

are providing care as a foster parent inside the foster care system or outside the 

child welfare system. Just as it is important to provide supports to birth parents to

keep children safely with them whenever possible, it is equally imperative to provide 

kinship families and grandfamilies with the supports and services they need so that all 

members of the family can thrive

When children cannot remain in the home of their parents, they typically begin a 

journey on one of two possible paths. A minority of children enter the foster care

system. Their caregivers may be their own relatives who are licensed as foster parents

(kinship care), they may be non-relative licensed foster parents, or the children live in 

some other arrangement (e.g., a group hom

In most cases, however, the children do not move into the foster care system. Instead,

their grandparents, close relatives, or family friends step in and raise the children, often 

without support, for a period of time and sometimes indefinitely, without the benefits, 

support, and assistance of the child welfare system

Accurate data about the prevalence of these families is extremely limited, and most 

estimates are believed to be an undercount. According to the five-year estimates from

the 2019 American Community Survey (ACS), 2,741,869 children were living with 

grandparents who were responsible for most of their basic needs. More than a third of

these children (991,929) lived with grandparents who were responsible for their basic 

needs and had no parent present in the household (U.S. Census Bureau, 2019). T

majority of these families exist outside the foster care system, meaning they do not 

receive supports and services and/or financial assistance to raise the children

The ACS prevalence data is likely an undercount reflecting the challenges inherent in 

developing survey tools that reflect the diversity of these families. For example, the

ACS does not collect information about relatives other than grandparents who are 

caring for children. Similarly, it does not account for close family friends who step in

to prevent a child from being placed in foster care, nor does it measure the unknown 

number of grandparents (or kin) caring for grandchildren over the age of 18 who 

live with disabilities. For every kinship family and grandfamily counted by the U

Census Bureau, there are likely many others who are unrecorded and unsupported

In fact, analysis conducted by Annie E. Casey Foundation’s Kids Count Data Center
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 3

suggests that 4% of all children in the U.S. (or 2,791,000 children in 2019) lived “i

households where a grandparent provides that child’s primary care” (Annie E. Casey

Foundation, 2019)

“The majority of the systems serving kinship families and grandfamilies 

were not designed with these families in mind. Outreach efforts often 

miss the families. Kinship families and grandfamilies often spend down their 

savings to pay for health care or other services for the children, only to later 

find out they could have qualified for other assistance.”

-Jaia Peterson Lent, Co-chair of the Advisory Council to Support Grandparents Raising 

Grandchildren

Understanding the actual prevalence of children living with grandparents and other kin 

is critical because a significant and growing body of research has shown that children 

both inside and outside of the foster care system have better outcomes when they live 

with family (Generations United, 2016). However, while today’s grandparents and other

relatives are an energetic and vital generation, ready and able to protect the children 

they love, the children often need more support than a kin or grandparent caregiver 

can provide alone. Many of the children in need of homes have experienced multiple

adverse childhood experiences, or ACEs. Some of the children in need of homes

have experienced trauma or witnessed traumatic events such as overdoses, domestic 

violence, and even deaths. Others have experienced maltreatment (Generations

United, 2017). A significant number suffered exposure to harmful substances before

birth, putting them at risk for lifelong problems including developmental delays, 

behavioral disorders, and mental health disorders

According to the CDC, “women and racial/ethnic minority populations are at a greater 

risk for having experienced four or more types of ACEs” (Centers for Disease Control 

and Prevention, 2021). For more information on ACEs, refer to the following publications

■ Patterns of adverse childhood experiences and substance use among young 

adults: A latent class analysis 

■ The effect of multiple adverse childhood experiences on health: a systematic review 

and meta-analysis 

■ Effect of the type and number of adverse childhood experiences and the timing of 

adverse experiences on clinical outcomes in individuals with bipolar disorder 

Research has found that although most children exposed to ACEs are resilient 

without long lasting effects, cumulative exposure to ACEs can reverberate through a 

person’s life and can be linked with chronic health problems, serious mental illness, 

and substance use disorders in adulthood (Felitti, et al., 1998). During childhood an
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 4

adolescence, children with multiple ACEs may exhibit behaviors consistent with posttraumatic stress disorder (PTSD). These issues require professional interventions,

which should include evidence-based care such as trauma-focused cognitive 

behavioral therapy or other relevant treatments for relevant illness and symptoms 

to help these children grow and thrive. Sometimes, mental health symptoms follow

children into the classroom, requiring specialized education plans, school supports, 

and occupational therapy. For many kin and grandparent caregivers, the cost of the

mental, behavioral, and educational supports their children need are out of reach

It is not only the children who need support. In order to care for traumatized children,

the kin and grandparent caregivers themselves have to set aside tremendous sadness 

and grief over lost relationships with their adult children and the secondary trauma and 

emotional challenges that comes with exposure to what the children have experienced

They require culturally appropriate services and supports 

grounded in the principles of trauma-informed care to assist 

them in understanding and appropriately responding to the 

behaviors of the children, handling the secondary trauma 

they may experience, and managing their own stress. To

access these services, they also need a range of financial 

and practical assistance. This assistance would help them

maintain their health and well-being while navigating the 

bureaucracy, bias, stigma, shame, legal contests, and an 

endless stream of unanticipated expenses associated with 

raising a child, often later in life, while living on a fixed or 

limited income.

For a detailed 

discussion of the 

findings of the RFI, 

refer to Section 

IV, Discussion 

of Challenges 

and Systemic 

Gaps Identified in 

the Request for 

Information.

While the prevalence of kinship families and grandfamilies is growing in all communities 

across the nation, communities of color are disproportionately impacted by this 

issue. Even though Black or African American individuals represent just 13% of the

U.S. population, they make up nearly a quarter of all children in households where 

grandparent is responsible for the needs of the child. Similarly, American Indian and

Alaska Natives make up only 1.3% of the U.S. population, but their representation 

households where a grandparent is providing for most of a child’s needs is more than 

double that rate (U.S. Census Bureau, 2019). When kin and grandparent caregivers ta

on the demanding and important task of raising a child, they need culturally appropriate 

support, assistance, and public acknowledgement of their tremendous sacrifices

In developing a slate of recommendations to address these complex issues, the 

Advisory Council worked to integrate the voices and perspectives of a wide range 

of stakeholders, especially kin and grandparents. This report includes their voice

To understand the landscape of existing programs to support kin and grandparent 

caregivers, the Advisory Council worked with the Recognize, Assist, Include, Support, 

and Engage (RAISE) Act Family Caregiving Advisory Council on the development of 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 5

an inventory of federal programs and other useful information to support caregivers, 

including kinship families and grandfamilies. ACL also issued a formal Request for

Information (RFI) in December 2019 seeking information on the challenges and unmet 

needs of kin and grandparent caregivers. The RFI yielded a trove of heartrending

stories reflecting the concern kin and grandparent caregivers have for the future wellbeing of the children and their struggles to navigate complex legal, financial, and 

medical systems

Many of these issues are multifaceted and intertwined. This is particularly true for

financial and legal issues which—depending upon the situation of the family—often 

serve as the basis of a dense and complex web of unaddressed issues such as access 

to food and nutrition, education (including special education), respite care, mental 

health, substance use disorders, health, and health care. Without appropriate support,

these issues lead to increased stress and less time for self-care and respite among 

already overwhelmed kin and grandparent caregivers. That in turn puts them at risk for

poor health outcomes, depression, and caregiver burnout. Preventing these risks is in

the interest of everyone as millions of children depend on these caregivers every day

The information in the RFI analysis and the development of the inventory and best 

practices resource enabled the Advisory Council to outline remaining critical gaps in the 

existing systems of services and supports to kinship families and grandfamilies. Those

gaps formed the basis on which the Advisory Council developed recommendations 

for changes to the systems of supports for kinship families and grandfamilies to 

enhance the well-being of all children and their caregivers. The recommendations

also complement and support the recommendations developed by the RAISE Family 

Caregiving Advisory Council for how the federal government, states, tribes, territories, 

and communities—in partnership with the private sector—can better “Recognize, Assist, 

Include, Support, and Engage family caregivers.” Those recommendations are outlined in

the RAISE Family Caregivers Act Initial Report to Congress

Both sets of recommendations will inform the development of the National Family 

Caregiving Strategy, which is being developed by the Advisory Council in collaboration 

with the RAISE Family Caregiving Advisory Council. When fully developed, the

strategy will identify actions that communities, providers, government, and others 

are taking and may take to recognize and support family caregivers—including kin 

and grandparent caregivers. It will promote greater adoption of person- and familycentered care in all health care and long-term service and support settings, increase

use of evidence-informed tools, information, education, training supports, referral, and 

care coordination to increase support for caregivers and expand access to respite 

options. Finally, and this is especially important for kinship families and grandfamilies,

it will increase financial security and reduce workplace discrimination faced by 

caregivers, including kin and grandparents raising grandchildren
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 6

I. Introduction

“My day consist[s] of jumping out of bed starting breakfast, getting kids up and 

dressed. Kids are then fed, hair and teeth brushed. Jump in the car, drop one at 

school at 8 and the twins at 9. Hurry home start laundry and wash dishes and 

pick up. At 1:30 pm return to school to pick up the 5-year-olds. Get home make 

lunch and do any required school work and more household chores. At 3:30 

pick up 7-year-old, fix snacks, do homework, start dinner. A short bit of playtime 

then dinner and dishes. Then it is bath, and bedtime... By the way I am 70 and a 

disabled vet, and a widow.”

-Response to the RFI 

Family is the single most important influence on a child’s life. From the first moments,

babies depend on parents and family to nurture and protect them. As they grow,

children depend on their adult caregivers for their basic needs, and for shaping their 

development, identity, values, and sense of security. Throughout history and across

cultures, grandparents have played an important role in this experience. They are a

recognized source of wisdom and unconditional love for children. They nurture family

connections and foster cultural identity while providing trusted support to parents and 

children alike

In recent years, a significant body of academic research has also proven the wisdom of 

the ages: grandparents are a force for good. Children with grandparent figures in their

lives have better health, education, and behavioral outcomes than children who lack 

this source of unconditional love (Pulgaron, Marchante, Agosto, Lebron, & Delamater, 

2016) (Buchanan & Rotkirch, 2018)

Grandparents across the nation provide vital support for American families, serving 

as a financial safety net for their adult children and offering practical assistance along 

the way, such as child care. When unexpected tragedies happen and parents can

no longer care for their children, there is no one better suited to step in as primary 

caregiver than grandparents and those extended family members and close friends 

who know and love the children

Collectively known as “kinship families or grandfamilies,” families led by grandparents 

(or other relatives and close friends) are not a new phenomenon. Rooted in historical

patterns, custodial “grandparenting” has long been a strength of the African 

American community (Minkler & Fuller-Thompson, 2005). Black or African American

grandmothers in particular have played a critical role in keeping families together 

despite historically high rates of poverty and in response to the practice of separating 

families during slavery (Minkler & Fuller-Thompson, 2005). During the great migrations

of the early 20th century, many southern grandmothers cared for children while their 

parents traveled north in search of employment (Minkler & Fuller-Thompson, 2005)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 7

In Native American communities, elders—even those not biologically related to the 

child—traditionally assist in the raising of children and the passing on of sacred 

traditions and language. The cultural norms of elders and grandparents are consistently

held in high esteem across Tribal Nations (Brave Heart, 2007). Older adults are

viewed as cultural transmitters, oral historians, and wisdom keepers (Minkler & FullerThompson, 2005). Although practices and traditions vary by community, these extended

connections have helped preserve cultural identity and family bonds for generations 

(Generations United, 2020e). This is perhaps most clearly described by the poet

Raymond Young Bear, who was raised by his grandmother on the Meskwaki Tribal 

Settlement in Iowa. In his poem, Grandmother, Young Bear describes how, through her

devoted care, she passed on to him the knowledge and understanding of his culture and 

identity “like the light of someone stirring ashes from a sleeping fire at night.”

American Indian grandparents 

demonstrate resilience and strength in 

caring for their grandchildren despite 

the fact that many also experience 

resultant trauma from their own lived 

boarding school experiences. U

Bureau of Indian Affairs policy created 

a military-style boarding school system 

to “civilize” and assimilate American 

Indian children from 1891 through 

the mid-1980s (Archuleta, Child, 

Lomawaima, & Heard Museum, 2009)

Across American culture, the rearing of children by grandparents and extended family is 

a longstanding practice; examples abound of individuals raised in kinship families and 

grandfamilies who have made significant contributions to our society. Oprah Winfrey,

Willie Nelson, and Jamie Foxx are just a few notable individuals who were raised by 

grandparents. Barack Obama, who was raised from age 10 by his grandmother, wrote

that she was “the one who put off buying a new car or a new dress for herself so that I 

could have a better life. She poured everything she had into me.”

Children raised by kin and grandparent caregivers have also long been a familiar trope 

of children’s literature. Both Peter Parker (i.e., Spiderman) and Dorothy Gale of t

Wizard of Oz were raised by loving aunts; Star Wars’ Luke Skywalker was brought up 

by his step-uncle

What Causes Kinship Families and Grandfamilies to Form?

In recent years, kinship families and grandfamilies have risen to national attention, due 

in part to the opioid crisis, which has contributed to a striking growth in the number 

Notable Individuals Raised by Kin and 

Grandparent Caregivers

• Olympic gymnast Simone Biles 

• Actress and comedian Carol Burnett

• Poet Langston Hughes

• Rapper Curtis Jackson 

• TV presenter Vanna White 

To read a collection of inspiring stories 

about children raised by kinship families 

and grandfamilies, refer to Grand 

Successes: Stories of Lives Well Lived.
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 8

of kinship families and grandfamilies, particularly among white Americans (Anderson, 

2019). States with higher rates of opioid prescribing also have higher rates of people

over age 30 raising grandchildren, according to the U.S. Census Bureau (Anderson

2019). However, the opioid epidemic is just part of the stor

Kinship families and grandfamilies form in response to a wide range of circumstances 

including substance use disorders, parental incarceration, economic instability, military 

deployment, serious mental illness, death, and adverse immigration actions. Because

of the events that lead to the formation of kinship families and grandfamilies, many 

of the children involved are at a high risk of emotional disturbance, juvenile justice 

involvement, and failure to thrive in school

The difference between kinship families and 

grandfamilies of the past and those emerging today 

is that the number of children in need of loving 

kinship or grandparent caregivers is greater than 

ever before and the systems to support families in 

need do not recognize or understand the unique 

needs of these families

For more on how the opioid 

epidemic has created and 

challenged kinship families 

and grandfamilies, refer to 

Spotlight on the Impact of 

the Opioid Epidemic.

Prevalence of Kinship Families and Grandfamilies

“While it appears that the data regarding the number of children being 

raised by grandparents differ by source, there is an overwhelming belief 

that these numbers are underestimated.”

-Response to the RFI 

Accurate data about the prevalence of these families is extremely limited, and most 

estimates are believed to be an undercount. According to the five-year estimates

from the 2019 American Community Survey (ACS), 2,741,869 children were living with 

grandparents who were responsible for most of their basic needs. More than a third of

these children (991,929) lived with grandparents who were responsible for their basic 

needs and had no parent present in the household (U.S. Census Bureau, 2019). It 

important to note that these figures are most likely an undercount, in part because the 

available data collection instruments are not designed to reflect and account for the 

diversity and unique circumstances of kinship families and grandfamilies

The ACS survey data collected by the Census Bureau is derived from 295,000 

addresses each month and provides a robust pool of demographic information

However, based on other surveys and data sources analyzed for this report, the actual 

number of kinship families and grandfamilies likely exceeds the estimates provided by 

the ACS. Additionally, the findings of the ACS data may be further limited because it

may not include many kinship families and grandfamilies who do not self-identify as 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 9

such for a number of reasons including privacy concerns, a perception that the family’s 

situation is temporary, or for cultural reasons

For every child counted by the census, there are likely many others who are 

unrecorded and unsupported. For example, analysis of multiple data sources

conducted by Annie E. Casey Foundation’s Kids Count Data Center has estimated

that the percentage of children in the U.S. whose care is provided primarily b

grandparents is 4% of the overall child population, or 2,791,000 children in 2019

(Annie E. Casey Foundation, 2019). That figure is nearly three times higher than th

ACS figure for grandparents raising children without a parent present

These figures may also be undercounts because of the challenges involved in 

tabulating other types of kinship relationships (e.g., aunts, uncles, cousins, siblings

families of choice) that are a part of this population. In addition, they do not include

adult children with disabilities whose independence and quality of life are supported by 

grandparents, kin, or close family friends

The Advisory Council recognizes that understanding the statistical prevalence of 

kinship families and grandfamilies is a crucial step in developing systems that support 

their needs. As a result, the Advisory Council developed a set of three inter-related

recommendations to enhance research, data, and the promotion of evidencesupported practices for this population

Meanwhile, the circumstances under which these families exist have become 

increasingly challenging. Just as data collection tools are not designed for kinship

families and grandfamilies, the child welfare system is not designed to recognize 

and support their needs. While there is increasing recognition of the importance

of providing supports to birth parents to keep children safely with them whenever 

possible, it is equally imperative to provide kinship families and grandfamilies with 

the supports and services they need so that all members of the family can thrive, 

regardless of the circumstances that lead to their formation

“Inside” and “Outside” the System (...and Why This Matters)

“Because I intervened before CPS [child protective services] became involved, I 

do not receive the same assistance that grandparent/kinship caregivers receive. I 

am desperate for help. I receive $271 for TANF [Temporary Assistance for Needy 

Families], and $308 food assistance each month. That is it. I have two chronic and 

at times, debilitating autoimmune disorders (rheumatoid arthritis and scleroderma) 

that limits my earning potential greatly, not to mention issues with affordable child 

care, [it] ... makes me fuming angry and sad at the same time.”

-Response to the RFI 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 10

Kinship families and grandfamilies live in an enormous range of circumstances. The

Advisory Council recognizes there are an infinite range of possible circumstances within 

the lives of the families across the nation. Nonetheless, for the purposes of the present

discussion, this report uses a binary framework that refers to families that exist within the 

foster care system as “inside” the system and those supporting children “on their own” 

with no involvement from children welfare systems as “outside” the system. In reality,

there can be overlaps between categories due to variations in programs and system 

administration across states and communities and as families change over time

Generally, when children cannot remain with their parents, they typically encounter 

one of two paths. In the minority of cases, they enter the foster care system where

they are placed in the legal custody of the state. Their foster care caregivers (i.e

foster parents) may be their own relatives who have been licensed as foster parents 

(sometimes this is called “kinship care”), they may be foster parents with whom the 

children do not have a relationship, or the children may live in some other foster 

care arrangement. On September 30, 2019, a day for which the Administration for

Children & Families (ACF) provides a representative statistical snapshot, there were an 

estimated 423,997 children in foster care. Thirty-two percent of those children lived

with relatives serving as licensed foster parents, and 46% lived with nonrelatives. The

remaining children lived in institutions, trial homes, group homes, pre-adoptive homes, 

supervised independent living, or had run away (Children’s Bureau, Administration for 

Children & Families, 2021)

Most children, however, do not enter foster care for a variety of complex reasons 

which are discussed later in this report. Instead, their grandparents, relatives, or

beloved family friends step in (often on short notice) to take responsibility of the child, 

typically with little preparation or training, financial assistance, or social support

Sometimes the process for this is an alternative to foster care called “diversion,” 

whereby a case worker will “place” a child with a relative rather than place the child 

within the custody of the state. Diversion may include voluntary placements, private

custody or guardianship in a private third party proceeding, where they either have 

consent of the parents or must prove unfitness or abandonment. For these kin, legal

representation is practically nonexistent (Wallace & Lee, 2013). After the child is

placed with his or her relatives, the state has little to no involvement, and the family 

receives no monthly subsidy payment and no assistance with accessing other financial 

supports or child welfare and health services (Malm, Sepulveda, & Abbott, 2019). This

practice varies considerably by state and jurisdiction, which makes prevalence difficult 

to determine. Some analysts suggest that “100,000 to 300,000 children are diverted

from foster care to live with relatives each year” (Malm, Sepulveda, & Abbott, 2019)

In other instances, a grandparent may notice that his or her adult child is not able to 

provide adequate care for the grandchild for some reason. In response, they step in
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 11

to provide care. This can happen when a parent is incarcerated or dies. It can als

happen when a parent neglects a child due to addiction or lacks the financial means to 

raise a child

In either of the above cases—diversion practices on the part of case workers or kin 

and grandparent caregivers stepping in proactively—taking responsibility for a child 

can happen at a few hours’ notice or slowly over time. It can last for months, years, or

indefinitely depending on the circumstances of the family and the needs of the child

These children, living outside the foster care system, make up the vast majority of 

children in kinship families and grandfamilies today

A 2020 report released by the Government Accountability Office (GAO) using a 

combination of American Community Survey data from 2018 and data from HHS’s 

Adoption and Foster Care Analysis and Reporting System found that of an estimated 

2,733,000 children in 2018 who were living with kin and grandparent caregivers, 

only 139,000 were in foster care with a kin or grandparent caregiver2. The rest of the

children living with kin and grandparent caregivers, (94% or 2,594,000 children) were 

living outside the foster care system. There are very few formal supports and services

in place to assist these families, nor is there public recognition of the tremendous 

challenges they face and the sacrifice caregivers are making to assist, love, and 

protect the children

This lack of recognition and support is important to this discussion because a 

significant and growing body of research has shown that children do better when they 

live with family. Caregivers are stepping up to become primary caregivers to children,

often on short notice, and this generosity places their financial, physical, and emotional 

well-being at risk

Why Kinship Families and Grandfamilies Need Recognition and Support

“I am a single, 49-year-old divorced grandmother raising my grands, ages 

5 and 7, with zero parental support. I am ... suffering alone, in silence, and 

I am but one of many others, with situations nearly mirroring mine.”

-Response to the RFI 

While kin and grandparent caregivers hail from every corner of the nation and 

represent all demographics, they are more likely than other families to live in poverty

Forty-three percent of the children who lived with a “grandmother-only” in 2012 lived in 

poverty; these children are disproportionately Black or African American (U.S. Censu

Bureau, 2019). In fact, according to the American Community Survey, ethnically and

culturally diverse populations are disproportionately represented in kinship families and 

grandfamilies. While Black or African American individuals represent just 13% of the

U.S. population, they make up nearly a quarter of all children in households where 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 12

grandparent is responsible for the needs of the child. Similarly, American Indian and

Alaska Natives make up only 1.3% of the U.S. population, but their representati

in grandparent-led households where the grandparent is providing for most of their 

needs, is more than double that rate (U.S. Census Bureau, 201

The available data on grandparents responsible for grandchildren suggests that 

underserved racial and ethnic populations are disproportionately taking responsibility 

for grandchildren. While the opioid epidemic has illuminated the experiences of

white families raising grandchildren, this population is less likely to be represented in 

kinship families and grandfamilies. Table 1 shows a side-by-side comparison of overall

population estimates for 2019 using the five-year population estimates of the children 

being raised by grandparents. As previously noted, ACS data presents, at best, an

incomplete picture because it only includes “grandparents” who are responsible for 

most of the needs of their own grandchildren and does not include other relationships 

or adult children with disabilities

Table 1. Side-by-side comparison of estimated racial and ethnic representation in grandparent-led 

households according to 2019 American Community Survey 5-year estimates.

Race/ethnicity

2019 U.S. Census 

Bureau Estimates 

of Self-Identified 

Racial Categories3

2019 Estimates of 

Racial and Ethnic 

Representation 

Among Children in the 

Care of Grandparents4

2019 Estimates of 

Racial and Ethnic 

Representation 

Among Grandparent 

Heads of Household 

Also Mostly 

Responsible for 

Grandchildren5

Non-Hispanic 

White

60.3% 41.4% 53

Hispanic and 

Latino (of any race)

18.5% 24.0% 19

Black or African 

American

13.4% 24.8% 20

Asian 5.9% 1.6% 3

Two or more races 2.8% 8.3% 2

Native Americans 

and Alaska Natives

1.3% 2.7% 2

Native Hawaiians 

and Other Pacific 

Islanders

0.2% 0.3% 0

Caregivers in kinship families and grandfamilies are also more likely to live with 

disabilities than the general population. According to ACS data, about a quarter of the

heads of household in families led by a grandparent live with a disability (U.S. Censu

Bureau, 2019)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 13

Adverse Childhood Experiences

“My son was murdered in 2010, and with the children in my care we all were 

completely devastated. When they came back to school, people who knew about 

the situation were sympathetic but did not know how to comfort the kids. There 

was no specialized staff member who knew how to approach children of homicide.”

-Response to the RFI 

A subset of the children in kinship families and grandfamilies need more support than 

a kin or grandparent caregiver alone can provide. This is often due to exposure to

adverse childhood experiences, or ACEs, during the events that led to the formation 

of the new family. Research has found exposure to ACEs can reverberate over the

lifespan. It is linked with chronic health problems, serious mental illness, and substance

use disorders in adulthood. Some of the children in need of homes have experienced

trauma or witnessed traumatic events such as overdoses, domestic violence, and death

Others have experienced abuse and neglect. A significant number suffered exposure

to harmful substances before birth, putting them at risk for lifelong problems including 

developmental delays, behavioral disorders, and mental health disorders

As a result of their exposure to ACEs, some children may experience symptoms of 

post-traumatic stress disorder or other mental illnesses. Respondents to the RFI noted

behaviors in the children in their care that could be signs the child has been exposed 

to trauma. Examples noted by RFI respondents include attachment disorders, food

hoarding, separation anxiety, difficulty sleeping, and self-harm. These issues require

professional interventions, including extensive clinical and educational supports to help 

these children grow and thrive. Often these issues follow them into the classroom,

requiring specialized education plans, school supports, and occupational therapy

For many kin and grandparent caregivers the cost of the mental, behavioral, and 

educational supports their children need are out of reach

Even though becoming a licensed foster parent comes with financial assistance, many 

kinship families or grandfamilies do not choose this option for a variety of reasons

Some prefer not to give custody of the child to the state. Others are not given the

option or are discouraged from becoming licensed foster parents. For example,

caseworkers may emphasize that becoming a licensed foster parent is an extensive 

process without giving balanced information about the financial support that comes 

with licensure. Licensed foster parents have to comply with requirements such as

background checks, mandatory visits with birth parents, personal assessments, and 

home safety inspections. Other families who step in before the child welfare system

becomes involved lack information about how to become licensed foster parents

The small percentage of families that are part of the foster care system receive 

some benefits. Those who are not fully licensed do not receive the same foster
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 14

care maintenance payment as licensed families. The benefits families receive vary

considerably by state. Generally, they can include modest reimbursement subsidies

for the child’s daily needs, clothing allotments, transportation allotments, Medicaid 

insurance, and tax credits, in addition to support from case workers and access to 

educational and supportive services

However, the majority of kinship families and grandfamilies do not have access 

to these supports and services. And while a legal relationship to the child is not

required to access public benefits, affordable housing, or claim tax credits for the 

child, the lack of such a relationship can pose barriers and there are few available 

sources of trusted information

On top of this, rearing a second family — often with no time for advance planning — is 

challenging in today’s environment. Regardless of whether they are inside or outside

the system, kin and grandparent caregivers over all ages are more likely to experience 

“negative changes in health behavior, depression, and self-rated health” (Hughes, 

Waite, LaPierre, & Luo, 2007)

A lack of awareness and inclusion across the broader society, in turn, makes it 

difficult for caregivers of children outside of foster care to complete straightforward 

but critical tasks such as registering the child for school and accessing medical 

records. The children often miss out on essential services and supports — like health

care, dental care, counseling, nutrition assistance, and even educational programs

Public awareness is limited; when it comes to the few supports currently available, 

for example, Kinship navigator programs or support groups, kinship families and 

grandfamilies are often misunderstood and experience stigma.

To address these complex and interconnected issues, Congress authorized the 

Supporting Grandparents Raising Grandchildren Act (Public Law 115-196). One

of the key charges of the SGRG Act is to convene an advisory council to develop 

recommendations to provide the nation’s kin and grandparent caregivers “better 

coordination and dissemination of information and resources available to support them 

in their caregiving responsibilities.”

This initial report to Congress by the Advisory Council includes 22 recommendations 

for changes to the formal and informal systems of supports for kinship families and 

grandfamilies to enhance the well-being of all children and their caregivers. In addition, it

■ Shows the unique strengths of kinship families and grandfamilies, and the 

challenges they face

■ Documents kin and grandparent caregivers’ unmet needs, including those identified 

in a formal RFI issued by ACL in December 2019
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 15

■ Outlines critical gaps in the existing systems of services and supports to of kinship 

families and grandfamilies

■ Describes current best practices, federal and non-federal resources, and other 

useful information for grandparents and other older relatives raising grandchildren

Refer to Section II. Passage of the Supporting Grandparents Raising Grandchildren

Act for more information on the efforts of the Advisory Council and the outcomes of 

their work

Toward a National Family Caregiving Strategy

 “Kinship caregivers become overwhelmed without support. Most kinship 

families are fearful of the system and will not ask for help. This leads to the 

potential for placement disruptions and entry into the foster care system. 

This can be traumatic for all involved.”

-Gail Engel, grandparent and member of the Advisory Council to 

Support Grandparents Raising Grandchildren

Kinship families and grandfamilies are a specific type of family caregivers. In recent

years, thanks to the efforts of a broad constituency of advocates and families, there is 

increasing awareness of the need to better recognize and support family caregivers

The RAISE Family Caregivers Act, which became law in January 2018, directs the 

Secretary of Health and Human Services to develop a National Family Caregiving 

Strategy. The strategy will set a course for the implementation of consistent actions

that federal, state, local, and tribal governments, health care providers, and long-term 

services and supports providers will take to ensure the needs of caregivers, including 

kin and grandparent caregivers, are addressed in a holistic and coordinated manner

The first steps of developing such a strategy involve understanding and documenting 

the existing federal supports in place to assist these families and identifying gaps 

and areas of duplicated effort. Federal members of both the Advisory Council and the

RAISE Family Caregiving Advisory Council, developed an inventory of federally funded 

programs, including those that address the needs of kin and grandparent caregivers

This inventory, along with the work of both councils will allow policy makers to analyze 

and assess the landscape of available programs to better ensure efficient distribution 

of resources and prevent program duplication, a key component of the strategy

For more information on ACL’s implementation of the requirements of the RAISE Act 

and the forthcoming development of the National Family Caregiving Strategy, visit the 

RAISE Family Caregiving Advisory Council webpage
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 16

Spotlight on the Impact of the Opioid Epidemic

Substance use disorders can be a challenge for any family, but for kinship families and 

grandfamilies, it may have a compounding effect. Substance use disorders, including

alcohol, opioids, and other drug misuse, can be a causative factor for kinship families 

and grandfamilies. The presence of substance use disorders in the lives of these

families creates additional challenges both for the adults and for the children who were 

potentially exposed to harmful chemicals in utero or experienced trauma related to 

substance use

“It’s hard watching my child go through her addictions. It’s even harder 

watching my granddaughters being split apart and their lives flipped upside 

down because of the lack of empathy for kids in their situation.”

-Response to the RFI 

According to the CDC, more than 750,000 Americans have lost their lives from 

overdoses since 1999. The overdose crisis is evolving, and rates of overdose have

increased exponentially since at least 1980, driven by distinct waves involving different 

drugs (and drug classes) at different times (Jalal, et al., 2018). Since 2013, overdos

deaths have been driven mainly by opioids—first by prescription opioids, then by illicit 

heroin, and more recently by illicitly manufactured fentanyl and fentanyl analogs. In

2020, of the reported 94,134 overdose deaths in the U.S., 70,456 involved opioi

Provisional data indicates that the COVID-19 pandemic has only exacerbated the 

overdose crisis (Centers for Disease Control and Prevention, 2020)

Ripple Effect

“When my son was in treatment, there was not services to assist with the 

kids left behind and for myself. They just focus on the parent, and their 

classes. After they attend their classes and support meetings, they are 

released, and the kids go back. The kids are still traumatized by their parents’ 

behavior and if there is a relapse, the whole circus starts up again. Then the 

grandparent has to pick up again and start the whole process over.”

-Response to the RFI 

While opioids are not the sole cause of these increases, their impact on kinship 

families and grandfamilies cannot be understated. According to the Altarum Institute,

“the ripple effects of the opioid crisis are rapidly accumulating, resulting in—among 

other consequences—a dramatic uptick in the number of children being removed from 

the custody of their parents” (Stanik, 2018). Between 2012 and 2016, the nation saw

a 10% increase in the number of children entering foster care. In some states, such as

Minnesota, the increase was as much as 50%. Across the nation, states are required
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 17

to place children with relatives if possible. This has increased the number of kin and

grandparent caregivers, many of whom receive little to no support or assistance. While

the media covers stories about the causes of kinship families and grandfamilies, little 

attention is given to the myriad ways these new families struggle to stay afloat in the 

wake of such tragedies

Recommendations for Better Supporting Families Affected by Substance 

Use Disorders

A 2018 update of the Generations United report Raising the Children of the 

Opioid Epidemic: Solutions and Support for Grandfamilies proposed a number of 

recommendations to support kinship families and grandfamilies in light of the opioid 

epidemic. These include

■ Encouraging states to offer a continuum of tailored services and supports for 

children, parents, and caregivers through the Family First Prevention Services Act

■ Ensuring a family-first approach, placing children with kin first whenever possible

■ Ensuring kinship families and grandfamilies affected by the opioid epidemic receive 

the support they need

■ Promoting the support of kinship families and grandfamilies through existing 

programs

■ Expanding legal options for kinship families and grandfamilies

■ Promoting best practices to support the needs of kinship families and 

grandfamilies

“My daughter is an addict, started after the birth of her son that I am 

now raising. Her addiction started with pain pills, then to Suboxone, then alcohol, 

to cocaine and meth, and prostitution that led to rapes and trafficking, etc. 

Her children, my grands, have been with me full time for a little over 

2 years because of her addiction.”

-Response to the RFI 

Strengths and Benefits of Kinship Families and Grandfamilies

Despite the many challenges outlined above, decades of research have confirmed 

that kinship families and grandfamilies are a force for good in the lives of children 

who cannot remain with their parents. Researchers have documented increases in

child safety, stability, permanence, and well-being among children raised by kin and 

grandparent caregivers (Annie E. Casey Foundation, 2012
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 18

Children Thrive in Kinship Families and Grandfamilies

Children in foster care with relatives have more stable and safe childhoods compared 

to children in foster care with non-relatives (Generations United, 2016). They

experience fewer school changes and behavioral and mental health problems. More

importantly, because they are living with relatives, they also have a greater likelihood 

of remaining in the home as they transition to young adulthood, which prevents them 

from joining the ranks of the 23,000 children who “age out” of the foster care system 

each year (Generations United, 2016). Aging out of foster care is associated with

homelessness among young adults, higher rates of unemployment, and an increased 

likelihood of becoming pregnant before age 21 (National Foster Youth Institute, 

2017). Moreover, many families report that when children remain with their siblings

and within their extended families, they experience a sense of identity and belonging 

that is frequently lost when a child is placed with non-relatives who cannot pass 

along cultural identity in the form of family memories, photographs, stories, food, 

music, and traditions

Research finds that children in the care of kin and grandparent caregivers are less 

likely to try to run away than those in the care of non-relatives or residing in group 

homes; they are more likely to like the people they live with and more likely to report 

that they “always felt loved” (Generations United, 2016). This is important because

the need for the affection and love that kin and grandparent caregivers bring cannot 

be understated. The children in kinship families and grandfamilies have experienced

trauma, abuse, and/or neglect. Many of the respondents to ACL’s RFI shared that

the children in their care had learning disabilities, behavioral issues, depression, and 

severe anxiety because of their parents’ actions. According to Generations United,

“more than half of children involved with the child welfare system have experienced at 

least four ACEs, leaving them 12 times more likely to have negative health outcomes 

than the general child population” (Generations United, 2017). Even the experience

of removal from the parental home, regardless of how unsafe it may have been, is 

traumatic for a child

The love and care that kin and grandparent caregivers provide mitigates the stress 

of these childhood experiences. It helps children learn to cope with stress, develop

a healthy stress response, and build resiliency. The unconditional love of a “parental

figure” in the face of negative childhood experiences has been shown to have a 

protective effect on these children, building resiliency and helping them heal from the 

trauma that they may have experienced (Carroll, et al., 2013

 “Raising a child at 69 as a single parent is daunting. But I love him.”

-Response to the RFI 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 19

Other Tangible and Intangible Benefits

Children are not the only people who benefit from kinship families and grandfamilies

Despite the challenges, the adults in these families experience immense satisfaction, 

pride, and meaning due to their efforts. The RFI yielded dozens of testimonials about

the benefits and rewards of taking on full responsibility for raising a grandchild

These include joy, an increased sense of purpose, the opportunity to nurture family 

relationships, and the satisfaction of knowing they are keeping the child safe from 

harm. Taxpayers also benefit from the efforts of kin and grandparent caregivers. B

stepping forward to raise children who would otherwise be placed in the custody of 

the state, kin and grandparent caregivers keep children safely with family and save 

taxpayers more than $4 billion each year (Generations United, 2020f)

The contributions of kin and grandparent caregivers come at significant personal and 

financial cost. Kinship families and grandfamilies bring a tremendous amount of love

and care to the raising of children. But love alone is not enough. Given the sacrifice

kin and grandparent caregivers make and the undeniable needs of the children in their 

care, these families deserve recognition, support, and assistance to do what families 

do best: raise healthy children
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 20

II. Passage of the Supporting Grandparents Raising 

Grandchildren Act

To heighten visibility and address the need for better support, information, and 

services to assist kinship families and grandfamilies, Congress passed the Supporting 

Grandparents Raising Grandchildren (SGRG) Act (Public Law 115-196) in 2018. The

SGRG Act, signed into law in July 2018, authorized the establishment of a council 

made up of grandparents who are raising grandchildren and representatives from 

federal agencies. Congress charged the Advisory Council with supporting kinship

families and grandfamilies through the identification and promotion of information, 

best practices, resources, and recommendations to ensure these caregivers meet 

the needs of the children in their care while at the same time are able to maintain 

their own physical and mental health, and emotional well-being. This vision includes

all kinship families and grandfamilies, regardless of their relationship to the child and 

whether they are providing care inside or outside the foster care system. Because of

the important role grandparents and elders play in Native communities, the SGRG Act 

also called for the Advisory Council specifically to consider the needs of members of 

Native American tribes

Advisory Council to Support Grandparents Raising Grandchildren

“Serving on this committee is a fabulous experience. Watching as big and small 

goals are achieved makes all the work even more meaningful! The efforts of the 

dynamic and diverse personalities of this committee is proof of how things can 

work for the common good when politics and individual prejudices are set aside.” 

–Bette Hoxie, member of the Advisory Council to Support Grandparents Raising Grandchildren

As a first step to implementing the requirements of the SGRG Act, ACL published a 

call for nominations of non-federal members in the Federal Register on October 12, 

2018. While the SGRG Act only called for two grandparent/older relatives and federal

officials, ACL chose to broaden the membership of the Advisory Council to reflect the 

diversity and complexity of the needs of kinship families and grandfamilies. ACL received

74 nominations of highly qualified individuals from diverse backgrounds, including 

academia, the justice system, and human services. Staff from across ACL reviewed

the nominations and recommended 18 nominees based on personal and professional 

experience with kin and grandparent caregiving and geographical distribution

The Advisory Council selectees represented a cross-section of advocacy and child 

welfare groups, academic institutions, and governmental programs. Eight members

have experience in advocacy, direct service, academia, and research. In addition,

many members of the Advisory Council, including some of the professional advocates 

and federal representatives, are themselves caregivers who have a nuanced 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 21

understanding of the unique rewards and challenges of raising a grandchild in the 

current environment. Representatives of federal agencies with programs and initiatives

that support kinship caregivers joined these non-federal members to form the full 

Advisory Council

Advisory Council Deliberations

In August 2019, the Advisory Council met in person in Washington, D.C. and eac

non-federal member was administered the oath of office (5 U.S.C § 3331) to serv

as a Special Government Employee. Since that inaugural meeting, Advisory Council

members have pursued their work with a high degree of purpose. Following the

COVID-19 outbreak, Advisory Council members were faced with the challenge 

of finding a safe way to continue to work, recognizing that some of the Advisory 

Council members were themselves older adults at greater risk of contracting the 

virus. To this end, members met virtually from March 2020 onward, adapting to this

new way of conducting business to continue to focus on supporting kinship families 

and grandfamilies

Mission of the Advisory Council

During the April 2020 full Advisory Council meeting, 150 members of the public joined 

the online platform to listen to the meeting and contribute via a public chat. During

the meeting, the Advisory Council discussed the terminology it would use to describe, 

consistently and inclusively, the families raising children. The Advisory Council also

solidified their vision statement and adopted a set of guiding principles that will shape 

their work to improve our nation’s response to the needs of grandparents and older 

relative caregivers

Former ACL Administrator and Assistant Secretary for Aging Lance Robertson, 

who also served as Advisory Council chair until January 2021, proposed a mission 

statement for the Advisory Council, which included text derived from the statute

Council members unanimously agreed to adopt the mission statement as follows:

“The mission of the Advisory Council to Support Grandparents Raising 

Grandchildren (SGRG) is to identify, promote, coordinate, and disseminate 

information, resources, and best practices to help grandparents and older 

relative caregivers of children meet the health, educational, nutritional, and 

other needs of the children in their care, while maintaining their own physical, 

mental, and emotional well-being. As part of this mission, all recommendations 

will consider the needs of members of Native American tribes and families 

affected by the opioid crisis.”
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 22

Vision Statement and Guiding Principles

During the same meeting, the Advisory Council drafted a vision statement and adopted 

a set of guiding principles that informed the recommendations that follow in this report:

“The Advisory Council to Support Grandparents Raising Grandchildren will be 

a leader for identifying and sharing resources to support, educate, empower, 

and advocate for kinship families and grandfamilies. The council will increase 

awareness and understanding of the needs of these families to ensure they are 

treated with respect and dignity. By honoring cultures, values, and diversities, 

we will create a better future so that families can flourish.”

The Advisory Council also collectively drafted, edited, and adopted a set of principles 

that have guided their work and the recommendations in this report. The agreed-upon

guiding principles of the Advisory Council include the following five statements: 

1. “We recognize and define kinship families and grandfamilies as families in whic

children reside with and are being raised by grandparents, or other extended family 

members, and adults with whom they have a close family-like relationship.

2. “Activities will promote greater adoption of person- and family-centered support

that place kinship families and grandfamilies at the center of every support system, 

while also acknowledging the challenge of possible conflicting goals.

3. “Efforts will aim to empower kinship families and grandfamilies to advocate fo

themselves to meet the needs of the child and family members. With improved

access to resources, they may engage and contribute meaningfully in their 

communities.

4. “Recommendations should recognize and support kinship families an

grandfamilies in a fair and impartial manner considering the physical, cultural, 

emotional, and financial impacts.

5. “The National Family Caregiving Strategy will include and amplify the voices o

kinship families and grandfamilies.
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 23

III. Understanding the Unique Needs of Kinship Families 

and Grandfamilies

Kinship families and grandfamilies face all the same challenges that families across the 

nation face when raising children—but their needs are often amplified because there 

are few resources and structural supports in place to assist them, and many do not 

have a legal relationship to the children, causing barriers to accessing supports and 

services on their behalf. Many are retired or receive disability benefits and therefore

have limited income to support themselves and their loved ones. Seldom are they

financially prepared to raise children in their later years. Others are still working and

trying to juggle the reality of suddenly caring for children while balancing their own 

needs. Meanwhile, regardless of their financial situation to start with, their expenses

are significant. They need safe and adequate space to live, nutritious meals, clothing

for school and play—in addition to health care, mental health support, tutoring, 

toys, transportation, phones, internet access for schoolwork, and timely access to 

information about health and safety. They also need to take care of their own health

and wellness needs—that means taking a meaningful break, making time to socialize 

with friends, and having the flexibility to attend a medical appointment or access 

senior services without a child in tow. Some senior housing developments also prohibit

children. Navigating the responsibility of raising traumatized children—while juggling

all these requirements—is more than a full-time job. These needs have only intensified

in the COVID-19 era. Understanding these unmet needs is a critical first step to

supporting the children in these families

Overview of the Existing Literature

In recent years, a body of research and analysis has emerged, extensively documenting 

the needs and challenges of kinship families and grandfamilies. This body of research

mirrors the findings of the RFI, notably that kinship families and grandfamilies are 

disproportionately impacted by the opioid epidemic, child abuse and neglect, domestic 

violence, parental incarceration, financial instability, and serious mental illness; that the 

number of children in the care of grandparents and other relatives is likely much larger 

than official numbers suggest; and that these families, as a consequence, struggle to 

meet the basic needs of both the children and adults involved

What follows is an overview of important studies and analysis of the causes and needs 

of kinship families and grandfamilies. It is not intended as a full literature review, but

rather a framework of the major themes noted by researchers

In 2020, researchers at George Mason University developed a framework for 

describing the unique experiences of members of grandfamilies using a family 

systems approach. The resulting paper, Compounding Complexity: Examining Multiple

Factors Leading to Challenges within Grandfamilies, explains that grandfamilies 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 24

These three categories 

of complexity all occur 

amidst conflict and 

change. Conflict often

arises from power 

dynamics between 

custodial grandparents 

and biological parents

Change also has a 

significant impact on 

these families and 

contributes to the 

complexity of their 

experiences

In their interviews, 

Tompkins and colleagues 

uncovered complex 

challenges in these 

families. One case

demonstrates all 

aspects of the Theory 

of Compounding 

Complexity:

“A grandfather, caring 

for his grandson, was 

holding onto emotions of guilt, regret and remorse for not being able to prevent the 

illegal behavior of his daughter and feelings of resentment and disapproval toward 

his daughter for making bad choices and not putting her child first. The daughter

expected her father to lessen the complexity of the situation by taking care of her 

child but still allowing her to parent from jail and pick up where she left off when 

she returned from prison (conflict). The grandson was fearful of living within the

neighborhood that his mother lived in once she got out of prison (change). Thus,

each family member had emotional responses to the situation and to the relationships 

involved which compounded the complexity of the situation.”

The Compounding Complexity theory provides an explanatory framework to show 

that the challenges faced by kinship families and grandfamilies are more than the sum 

of their parts. When conflict and change are combined with situational, relationship,

face a combination of three types of complexity: relationship complexity, situational 

complexity, and emotional complexity (Tompkins & Vander Linden, 2020)

Figure 3. How conflict and change contribute to compounding 

complexity for kinship families and grandfamilies (Tompkins & 

Vander Linden, 2020).
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 25

and emotional complexity, the resulting stress is not merely additive, it compounds, 

suggesting that interventions to support these families must go beyond addressing 

the surface problem (for example, child care), but also take into consideration the lived 

experience of adults and children who are part of kinship families and grandfamilies 

and the recognition that they are a unique kind of family that require interventions 

flexible enough to address their circumstances

Over time, each of those considerations affects other areas of the lives of kinship 

families and grandfamilies, creating a complex web that caregivers have to navigate 

just to ensure they and the children in their care have medical care, child care, 

safe housing, healthy food, and educational supports. Meanwhile, the caregivers

need to find time for a meaningful and restful break. At the same time that these

situational complexities are growing, the emotional complexities compound as kin and 

grandparent caregivers struggle to address their own stress amid mounting fatigue, 

and in an environment where mental health and educational resources are scarce. Add

to this the sadness and grief many grandparents feel, not to mention the social stigma 

they experience, and it is no surprise that kin and grandparent caregivers experience 

higher levels of stress and illness than people in the general population

Grandparents Raising Grandchildren: A Synthetic Review and Theoretical Model for 

Interventions, published in 2016 in the journal Family and Community Health, examined 

the causes and effects of custodial grandparenting through the use of a “stress-coping 

framework.” It lists issues such as caregiver substance use, child abuse and neglect,

intimate partner violence, and parental incarceration as contributing to already poor 

financial and health conditions, and so, the need for grandparents to step into the 

role of primary caregivers for their grandchildren (Choi, Sprang, & Eslinger, 2016)

Overall, the review finds that the major causes (i.e., stressors) leading to custodia

grandparenting are dysfunctional adult children as parents

Evidence from available research has shown that while kinship care placements 

with grandparents is very popular and commonly preferred to foster care, these 

arrangements lack adequate psychosocial support and financial assistance from child 

protection agencies to properly address the well-being of these caregivers and the 

children they care for, compared to other out of home placements. The research found

that the real impact of this disparity on the health and well-being of the children in 

these households, the caregivers, and the larger community remains undocumented 

(Choi, Sprang, & Eslinger, 2016)

The review identified the need to formulate formal, concrete financial services and 

recommended that attention should be given to the needs of culturally and ethnically 

diverse caregivers. While acknowledging the caregiving needs and experiences of

grandmothers for the greater good of their grandchildren, this research also includes 

the needs and experiences of custodial grandfathers, who like grandmothers, also play 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 26

an important role in the caregiving of their grandchildren but have received very little 

or no recognition in the past body of literature on grandparenting and face a different 

set of caregiving challenges and service needs compared to grandmothers. Some of

the important findings from the review include emotional, behavioral, and academic 

difficulties children in grandfamilies experience due to exposure to substance use, 

maltreatment, parenting instability, neglect, and loss, before placement with a 

grandparent. Also discussed are the shifts in the grandparent/grandchild relationship

once grandparents become the primary caregiver. The review posits that this type of

shift can lead to changes in relationships, finances, and physical and emotional health 

(Choi, Sprang, & Eslinger, 2016)

The GAO report TANF and Child Welfare Programs – Increased Data Sharing Could 

Improve Access to Benefits and Services, published in 2011, remains a valuable 

overview of one of the most often noted challenges experienced by kinship families 

and grandfamilies: lack of access to available financial support and services (U.

Government Accountability Office, 2011). According to the report, “GAO was

asked to examine the (1) trends and composition of the child-only caseload, (2) 

characteristics of caregivers and children in nonparent child-only cases, (3) factors 

influencing the level of benefits and services for children with non-parent caregivers, 

and (4) coordination efforts between state TANF and child welfare programs” (U.

Government Accountability Office, 2011). The report found that while programs do

exist to provide support to families, many kin and grandparent caregivers are not 

aware of these programs. The GAO report noted that increased “coordination among

programs that provide financial assistance and support to these families is one 

way to ensure that caregivers are aware of available resources” (U.S. Governmen

Accountability Office, 2011)

In a more recent GAO report, Child Welfare and Aging Programs – HHS Could Enhance 

Support for Grandparents and Other Relative Caregivers, released in 2020, the 

authors further explored the challenges faced by families when older relatives become 

caregivers of children. The report recommends sharing information and best practices

with states about federal programs serving kin. It found that data sharing could

enhance the delivery of services for older kin and grandparent caregivers under Title 

III of the Older Americans Act (OAA), which is administered by ACL, and Title IV-E of 

the Social Security Act, which is administered by ACF (U.S. Government Accountabilit

Office, 2020)

The 2015 article, Challenges and Resilience in African American Grandparents Raising 

Grandchildren: A Review of the Literature with Practice Implications, reviews the 

literature on “caregiving challenges and resilience in African American grandparent 

caregivers within a socio-cultural context” (Tang, Jang, & Carr Copeland, 2015)

Researchers estimate that African American grandparents are over three times more 

likely to raise their grandchildren, and as a result, make up a large proportion of kin 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 27

and grandparent caregivers. It explained that caregiving is stressful and has many

negative personal, interpersonal, and economic consequences. Overall, grandparents

experience a high level of financial risk, poor physical health, social isolation, role 

overload confusion, stress, and other related issues. Generally, financial constraints,

health concerns, legal issues involving custody, and the ability to provide for their 

grandchildren are noted as the most stressful issues for many grandparents. It is also

noted that incidents of depression, diabetes, hypertension, and insomnia are high 

among grandparent caregivers (Tang, Jang, & Carr Copeland, 2015)

Generations United has developed a number of reports and resources that have vastly 

expanded understanding of the needs of kinship families and grandfamilies. In Love

without Borders: Grandfamilies and Immigration, Generations United outlines the 

challenges faced by families affected by immigration actions. The report shows that 1

in 5 children in kinship families and grandfamilies is raised in an immigrant grandfamily 

and that detainment and deportation are a factor in the creation of kinship families 

and grandfamilies (Generations United, 2018a). The report explains that children

experience higher levels of trauma from living in dangerous and violent environments 

in their countries of origin, or due to their long and sometimes treacherous journeys to 

the U.S. In these types of situations, when children are separated from their parents

being cared for by a loving relative can act as a buffer from the effects of stress and 

trauma the children have endured. The report noted that between 2003 and 2013, the

U.S. deported more than 3.7 million immigrants and 20% to 25% of these deporte

were parents to U.S. citizen children (Generations United, 2018

The Generations United toolkit African American Grandfamilies: Helping Children 

Thrive Through Connection to Family and Culture details the rich history of kinship 

families and grandfamilies in African American culture and its implications for policy 

development. Among the benefits of kinship families and grandfamilies for African

American families are improved well-being, preserved cultural identity, and a reduction 

in the disproportionate number of African American children entering the foster care 

system. The toolkit notes that despite the well-documented benefits described above,

children and caregivers in kinship families and grandfamilies do not have access to 

the types and levels of support and services that are available to their counterparts 

in the foster care system. The toolkit notes that “while there is a tradition of African

American kinship care, factors such as parental substance abuse and disproportionate 

incarceration have changed the landscape and needs of these caregivers and children

Given the substantial, expanded, and disproportionate number of African American 

grandfamilies, understanding how individuals and systems need to provide appropriate 

and effective services within the current environment is essential” (Generations United, 

2020b)

A parallel toolkit, also developed by Generations United in partnership with the 

National Indian Child Welfare Association, American Indian and Alaska Native 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 28

Grandfamilies: Helping Children Thrive Through 

Connection to Family and Cultural Identity notes similar 

patterns exist for another ethnic group (Generations 

United, 2020c). Available studies on the best ways to

help children thrive when they can no longer remain with 

their parents have shown that they do best when raised 

by relatives. This is especially true for American Indian

and Alaska Native (AI/AN) children because each of the 

tribes is distinct in kinship structures, and cultural norms 

have traditionally engaged the extended family on issues 

of child rearing (Generations United, 2020c)

For more information 

on the unique needs of 

Native elders raising 

grandchildren, including 

case studies, refer to 

Section IV: Supporting 

Caregivers in Indian 

Country: Lessons 

from the ACL Title VI 

Programs.

In the 2017 update to its State of Grandfamilies report, titled In Loving Arms: The 

Protective Role of Grandparents and Other Relatives in Raising Children Exposed to 

Trauma, Generations United reported that over 51% of children in the child welfare 

system have had at least four ACEs, leaving them 12 times more likely to have 

negative health outcomes than children in the general population (Generations United, 

2017). The report calls for reform of federal child welfare financing to support kinship

navigator programs and increase use of “tailored, trauma-informed services and 

supports for children, birth parents, and caregivers to prevent children from entering 

or re-entering foster care.” The report notes that children in the foster care system are

five times more likely to suffer from anxiety, depression and/or behavior problems than 

children who are not in the system. However, children in foster care with relatives have

more stability, better mental and behavioral health and are more likely to report always 

feeling loved (Generations United, 2017)

The ACL Request for Information about Kinship Families and 

Grandfamilies

“I’m sure I’m speaking for so many people out there who have worked all 

their lives, paid their taxes, and have done the right thing in order to be able to 

retire and enjoy life. ... but now we can’t even do that because we can barely 

afford to buy food, clothing, and pay for shelter due to taking in our 

grandchildren and not receiving any extra help.”

-Response to the RFI 

While the sources above provide a basis of understanding, the Advisory Council also 

wanted to hear directly from kinship families and grandfamilies and the professionals 

who support them. ACL issued an RFI on December 7, 2019 via the ACL website

and the Federal Register. The RFI invited respondents to provide information on the

following overlapping areas:
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 29

■ Information, resources, programs and/or best practices to help kin and grandparent 

caregivers meet the diverse needs of the children in their care

■ Information, resources, programs and/or best practices to help kin and grandparent 

caregivers maintain their own physical and mental health, and emotional and 

financial well-being

■ Information on gaps and unmet needs that kin and grandparent caregivers 

experience, especially when it comes to services and supports that could alleviate 

some of the challenges they face

■ Recommendations on how the nation can best support kin and grandparent 

caregivers, including any applicable legislative changes that respondents believe 

could make a meaningful difference in the lives of these families

The RFI closed in February 2020 before the COVID-19 pandemic; therefore, responses 

did not touch upon the significant impact the public health emergency has had 

on kinship families and grandfamilies. Nonetheless, the 1,908 unique comments

submitted by over 300 respondents provided a trove of first-person narratives 

describing in detail the reality of caregiving for children in the present moment

Grandparent “Focus Group”

To further explore and understand the findings of the RFI, Community Catalyst, a 

Massachusetts-based organization contracted by the National Academy for State 

Health Policy and funded by The John A. Hartford Foundation, conducted an online

focus group in September 2020 with more than a dozen kin and grandparent 

caregivers. The session was part of a larger series of caregiving-related focus groups

to support the RAISE Family Caregiving Advisory Council in its future development of 

the National Family Caregiving Strategy. The focus groups were led by Pamela Nadash,

Ph.D., a professor at the University of Massachuset

This “grandparent focus group” took place virtually on September 24, 2020, during 

the COVID-19 pandemic. Dr. Nadash kicked off the discussion by asking participant

to identify a “silver lining” of the closures associated with the pandemic. Every

participant described the challenges associated with school closures, reduced access 

to supports and services such as nutrition and special education, not to mention the 

risk of infection. This latter concern was especially pressing given that some of the

participants were at greater risk of complications of the virus due to age or preexisting 

conditions. Despite these hurdles, each participant was able to also identify at least

one positive outcome of the pandemic. One participant noted that the way children

are raised today (as opposed to when she was raising her own biological children) 

feels “frenzied.” She said that during the pandemic, thanks to school closures and

cancellation of activities she was enjoying a quieter pace
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 30

Participants then spoke at length about the difficulty of taking a break from their 

caregiving responsibilities. For example:

■ Several noted they never left their grandchildren for safety or logistical reasons

■ Some of the logistical challenges faced by the grandparents reflect a general lack of 

public awareness of the circumstances faced by kinship families and grandfamilies

■ One participant, an older adult, described a medical provider telling her that 

children were not allowed in the office and she should leave her granddaughter 

in the car during the appointment. Given such an untenable choice, she did not

attend her medical appointment

■ Another noted that her eight-year-old grandson goes “everywhere” with her. As a

result, she and her husband have lost touch with friends

■ Still another participant shared that after a similar loss of social support system 

for the same reasons, he and his wife had found a new community for social 

engagement by joining a support group specifically for grandparents raising 

children

These observations helped provide context for the responses to the RFI and deepened 

the Advisory Council’s already rich understanding of the concerns of kinship families 

and grandfamilies, especially during the pandemic

RFI Findings

“The children that were exposed to drugs are growing up with 

medical and educational issues.”

-Response to the RFI 

ACL received 1,908 unique comments in response to the RFI from over 300 

respondents. Respondents included grandparents, family members, public and private

stakeholders, and tribal organizations. Many shared deeply moving accounts of the

day-to-day joys, hardships, and unforeseen circumstances that arise when raising 

grandchild or relative kin

The major themes that emerged from the RFI responses were not surprising. They

reflect the growing body of research showing that kin and grandparent caregivers 

experience significant financial strain in taking on responsibility of a child at a time 

in their lives when their peers are enjoying the fruits of retirement. In addition, they

take on significant amounts of stress and concerns about the children in their care 

as they struggle to navigate complex legal, financial, and medical systems that are 

not designed to meet their needs. As if these were not enough, they also often have

complicated—and sometimes contentious—relationships with the parents of the 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 31

children in their care and unaddressed grief over the events that caused the formation 

of their new family

“Many aged caregivers deplete any savings and even sell belongings to 

help with caring for grandchildren. In my case taking on 1 then another and both 

with special needs. (Cerebral Palsy and other has trauma needs) it was not 

a day that from 6:30am until 10:30pm I wasn’t busy every moment feeling 

at times that I may not make it thru another day.”

- Response to the RFI 

Figure 4. The challenges faced by Kinship Families and Grandfamilies combine and compound to 

create a complex web that families must navigate to survive.
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 32

Many of these issues are multifaceted and intertwined. This is particularly true of the

financial and legal issues which—depending upon the situation of the family—often 

create a ripple effect impacting housing, access to education, transportation options, 

availability of quality health care, nutrition, and mental health supports. Those issues, if

not addressed, in turn lead to increased stress and less time for self-care and respite 

for already depleted kin and grandparent caregivers

Still other respondents described how they were unprepared for the financial pressures 

and the consequences of taking on responsibility for a child or multiple children. These

consequences ranged from significant changes in income and the ability to pay for 

housing, health care, and food, to seemingly small, but nonetheless important issues, 

such as the comment from one grandmother that her grandchildren had learned to 

play cards because she could not afford electronics, including mobile devices

Another key trend throughout the RFI responses was that people frequently did not 

know where to go for support. This appeared to be true for both individuals new to

raising a grandchild and those with years or decades of experience. There simply is no

single resource that people can turn to for answers, advice, guidance, and support, 

leaving them to cobble together their own support systems based often on limited 

information—sometimes disinformation—and with few resources

Recommendations to address this issue included developing an app, launching a call 

center, building a website, and other ideas to offer a central clearinghouse of trusted 

information so that grandparents do not have to “go it alone,” as one respondent 

noted. Suggestions and comments were not limited to practical interventions, howeve

When asked if they believed kinship families and grandfamilies needed changes in 

federal legislation in order to thrive, the overwhelming response was in the affirmative; 

80% of respondents selected “Yes” for this question

“We are the new poor. I give up medications to have money to take 

care of my two granddaughters.”

-Response to the RFI 

Respondents also noted the logistical complexities that lack of finances and limited 

access to social supports create. One respondent described what it is like to be on a

waiting list for services for seven years. Another noted that she spends the time her

grandson is at school driving from one food pantry to the next trying to pull together 

enough food to feed a growing teenager because she simply cannot afford enough 

groceries on her limited income. A third respondent described the pain of supporting a

teen traumatized by her father’s suicide a decade earlier
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 33

A significant number of respondents represented ethnic and minority communities

Among respondents from Native communities, responses included reports that 

advocates, social workers, and health professionals frequently lack an understanding 

of the cultural norms experienced by Native people. Additionally, respondents noted

challenges around the processes for applying for financial benefits and support 

services, like tutoring. There were suggestions for developing stronger partnerships

and collaborations between tribal, state, and private organizations/agencies for the 

improvement of culturally relevant services to Native households

The multi-faceted diversity of kin and grandparent caregivers was also noted in the 

RFI. For example, while the term grandparent denotes advanced age, many of the

caregivers in these families are younger than age 60. Solutions designed for older

adults were not appropriate for this sub-population. Similarly, interventions designed

for metropolitan settings were inapplicable in rural settings. While this is true for most

public health issues, when it comes to supporting kinship families and grandfamilies, 

recommendations and proposed strategies must be flexible enough to address the 

needs of an extremely diverse population. That includes people who live in every

community across the nation and represent all ethnic and minority populations, are 

anywhere in age between 30 and 100 and includes all incomes (although a significant 

proportion live in poverty)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 34

IV. Discussion of Challenges and Systemic Gaps 

Identified in the RFI

“Five years ago, when I started this journey, I got more info from a 10-minute 

conversation with a stranger from an Al-Anon group than I could get ANYWHERE!”

-Response to the RFI 

The RFI specifically asked respondents to identify gaps and needs experienced 

by kinship families and grandfamilies. As noted above, slightly more than half of

the respondents to the RFI were grandparents, relatives, and family friends raising 

children. While the issues faced by kinship families and grandfamilies are numerous,

the following are the ranked order of concern as submitted by RFI respondents. Many

people addressed the same issue across multiple categories, thereby increasing the 

frequency to greater than 300 (the number of respondents)

Table 2. Overview of Issues and Concerns as Reported by Respondents to the RFI conducted in 

2019-2020.

Issues and Examples Cited by RFI Respondents Frequency Percentages

Finances (e.g., fixed income, additional expenses, insuranc

costs, unable to work) 581 20.91

Legislation/Laws (e.g., laws more favorable to biologica

parents, child benefits not transferrable) 289 10.40

Legal Assistance (e.g., high costs, expensive adoptio

process accessibility) 271 9.76

Schools/Education (e.g., special needs not adequatel

addressed, lack of school system support) 266 9.58

Substance Use Disorders (e.g., resources for biologica

parents, impact on children) 241 8.68

Housing (e.g., affordability, limited space, repairs

maintenance, children not accepted at 55+ communities, 

custody orders preventing relocation,)

215 7.74

Food/Nutrition (e.g., costs, nutritional value, special diets) 213 7.

Child Care (e.g., high costs) 195 7.

Respite (e.g., affordability, availability, quality) 156 5.

Physical Health (e.g., disabilities — children and caregivers) 145 5.

Mental/Emotional Health (e.g., stress, loss of socia

relationships, child trauma, separation, lack of support, grief) 105 3.78

Medical/Health (e.g., caregivers place their health afte

children, lack of self-care, children’s medical issues) 101 3.64
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 35

While the RFI was not a scientific instrument, its findings reflect a growing body of 

research developed over two decades, which firmly establishes that kinship families 

and grandfamilies have unique and specific needs and one-size-fits all solutions 

designed for other populations may not be applicable. When kinship families and

grandfamilies are formed, it typically involves some form of traumatic loss for the 

children as well as their caregivers. Inconsistent legal definitions and statutes often

make it difficult for kinship families to have access to financial resources. Over time,

these issues (trauma, lack of legal recognition, limited financial resources) interact and 

compound to affect all other areas of the family life including education, medical care, 

family relationships, child care, nutrition, and housing

The sections below describe each of the key areas of concern identified by RFI 

respondents. These discussions are intended as an overview. For each issue

additional reading resources are provided

Financial Challenges 

“As a social worker assisting families (grandparents that have become the 

placement of children taken into the care and control of a Tribal court), I have 

found it is very difficult for some grandparents to get financial assistance 

(TANF & Medicaid for the children in question). This needs to be simplified at a 

higher level so that each state (and local counties) don’t hinder this group from 

accessing much needed resources to take care of these children.”

-Response to the RFI

Many Caregivers Find it Challenging to Support a Family on Limited Income 

Financial unpreparedness for the cost of raising children, along with the financial 

uncertainty that comes with this responsibility, were among the predominant themes in 

responses to the RFI. Several respondents pointed out the urgency of their situation

One grandmother raising a teenage boy described the financial impacts of her decision 

to take in her grandson. Her remarks highlight the immediacy of the need for financial

assistance for this population: “People lose their houses because we can’t afford the 

cost of a child and no one seems to care that we’ll risk losing everything just to keep 

them safe...We need support to be able to care for them. We can no longer wait!!! Our

kids need the help now.

Kinship families and grandfamilies who step in to give care in times of crisis often feel 

they do not have a choice. Moreover, they do not have an opportunity to plan for the

financial cost of this decision. In addition to addressing the needs of the children in

their care, kin and grandparent caregivers also must make difficult choices to ensure 

that the children’s needs are met while also preparing for financial security in later life
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 36

“The kinship caregiver is put in a “catch-22” where they are having to 

decide between ensuring that the children in their care have what they 

need, and between holding down a job which in turn makes sure that the 

children in their care have what they need.”

-Patrick Donavan, Supervisor with Muskingum County Adult and Child Protective Services 

(Ohio) and a member of the Advisory Council to Support Grandparents Raising Grandchildren

To understand the financial challenges that kinship families and grandfamilies face, it is 

useful to look at demographics. Custodial grandparents and older kin and grandparent

caregivers typically have lower incomes and higher household expenses as compared 

to non-custodial grandparent caregivers. Approximately 1 in 5 kinship families and

grandfamilies live at or below the poverty line, a rate that far exceeds the poverty rate 

among parent-led households (Generations United, 2020a). Black or African American

kinship family and grandfamily households disproportionately experience financial 

need; children in these families are more than twice as likely to live at or below the 

poverty line as Hispanic/Latino or white children (Generations United, 2020a)

In addition, the direct and indirect financial costs of raising a child are considerable, 

and as noted above, families in these circumstances have little time to prepare

According to a report issued in 2016, by the Department of Agriculture, the annual 

cost of raising a child is between $12,350 and $13,900 each year (in 2015 dollars) 

(Lino et al, 2017). Multiple respondents to the RFI noted that because a significant

proportion of kin and grandparent caregivers are raising children who are survivors 

of trauma or have disabilities, the true cost is often much higher once mental health, 

special education, and even dietary needs are factored in

Limited Access to Financial Assistance Programs 

“Getting a $149 shelter benefit doesn’t begin to even pay for the cost of taking care 

of a child. I can’t afford to get kids into sports programs...I’m grateful we have food 

each day. These kids go through so many struggles and it is hard to not be able to 

give them the basic needs when I’m on disability and hearing folks say they would 

be better off if I let them go into foster care and have a chance to be adopted!” 

-Response to the RFI 

The majority of kin and grandparent caregivers are doing the same work as foster 

parents, yet they do not receive the same support or financial assistance that foster 

families have access to. When it comes to financial supports for kinship families and

grandfamilies outside the foster care system, there are only a few avenues of support

Following is a list of the types of financial assistance available to kinship families and 

grandfamilies, however, it is important to note that access to these resources varies by 

program and many families are not aware that these programs exist or how to apply
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 37

■ Temporary Assistance for Needy Families (TANF), which replaced Aid to Families 

with Dependent Children in 1996, is designed to address a variety of outcomes 

of child poverty. One of the primary program goals is to keep children in their own

homes or in the homes of relatives. Forty-one percent of child-only TANF units

include children living with non-parental caregivers, usually grandparents (Golden 

& Hawkins, TANF child-only cases, 2012). However, if all children eligible for TANF

were to receive support, the percentage would likely be higher. According to

Annie E. Casey Foundation, only 12% of eligible children in kinship families and

grandfamilies actually receive TANF support (Annie E. Casey Foundation, 2012

■ Supplemental Nutrition Assistance Program (SNAP) provides nutrition benefits to 

supplement the food budget of eligible families. According to the USDA, families

apply for SNAP through SNAP state agencies and must meet resource and income 

limit requirements determined by the state. SNAP also offers special rules for older

adults and people with disabilities. Annie E. Casey Foundation reports that “les

than half of low-income kinship care households receive assistance from SNAP, 

despite the fact that most report food insecurity” (Annie E. Casey Foundation,

2012)

■ The Social Security Administration administers benefit programs for which kin and 

grandparent caregivers or the children in their care may be eligible. For example,

disability benefits provide a financial lifeline that protects more than 1.7 million

children and the dependents of disabled workers who would otherwise face a 

high risk of either slipping into poverty due to reduced family income, dropping 

out of school, or both. It is payable to biological or adopted children, stepchildren,

grandchildren, or step grandchildren. Retirement benefits provide monthly support

to dependent children of retired parents and grandparents. The child benefits, in

addition to their own retirement benefits, provide the support retired workers need 

to care for their dependent children when they retire, by partially supplanting lost 

wages. Some children in kin or grandparent families may qualify to receive survivor

benefits or Supplemental Security Income for Children. However, individual cases

vary, and families are advised to contact the Social Security Administration to see if 

a particular child meets certain eligibility criteria

Each program comes with unique requirements, which create administrative barriers 

to participation. A major hurdle to accessing TANF, for example, is the requirement

that recipients assign their rights to child support to the states. This requirement

reduces access to benefits for kin who are fearful that when the state tries to locate 

the parent(s), the parent(s) will return to take the children, potentially placing the 

children at risk of harm. Some caregivers may fear that the pressure of child support

enforcement may make it more difficult for a parent struggling with substance use 

or other challenges to recover and eventually be able to safely parent their children

States have flexibility and can waive the child support requirements for “good cause” 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 38

if the caregivers can demonstrate that seeking child support is potentially harmful, 

however many states do not offer this option or make it widely known (Beltran, 2014)

These barriers have consequences for the short-term and long-term financial welfare 

of kinship families and grandfamilies. For example, TANF is often kin and grandparent

caregivers’ only source of financial support for raising grandchildren; however, 

obtaining TANF can be an arduous process for many families. One reason for this is

lack of understanding of the eligibility requirements at the local level; it is not out of the 

ordinary for a caregiver to be informally told by a caseworker that they are ineligible for 

TANF and therefore they do not complete the complicated application forms

 “Every family that takes on their grandchildren faces depleted income. 

We all know the reality is that it IS expensive to raise children. If 

your family chooses getting involved with foster care...there are some financial 

benefit[s] as well as support. Those of us who choose to gain 

custody ... receive no such financial support.”

-Response to the RFI 

For families who do receive them, TANF grants can provide a valuable, if limited, 

lifeline, which points to the need for policy reforms that make programs such as this 

easier for families’ access. This is important because TANF assistance represents

much more than just a monthly grant. Receiving TANF affects whether or not a family

qualifies for a range of other supports. Under some state policies, recipients of cash

assistance may also automatically qualify for Medicaid, child care, free school meals, 

education, and job training. That varies by state, however, and as noted, not all eligible

families are able to access TANF

For further discussion and an analysis of the financial complexities faced by kinship 

families and grandfamilies, including a list of resources, refer to the Financial 

Assistance - Summary & Analysis webpage on Grandfamilies.or

Legal Concerns and Assistance

“For grandparents that take on the responsibilities of care when needed 

but do not have legal rights or custody but provide constant financial 

support, worry endlessly about the grandchildren when they are in the 

care of the addicted parent- there is nothing for us.”

-Response to the RFI 

Closely linked to financial pressures is the lack of consistent financial and legal 

recognition for kinship families and grandfamilies, along with limited legal assistance
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 39

Legal Concerns Featured Prominently in the RFI Responses

Legal issues, including inconsistent legislation, were among the most prevalent 

responses from kin and grandparent caregivers and advocates in the RFI. Many

respondents explained that because of their lack of legal custodial guardianship, they 

faced significant legal barriers to accessing financial assistance, enrolling children in 

school, advocating for educational services, or consenting to health care, including 

emergencies. While there are numerous state and federal laws that address care of

children who cannot remain with their parents, these laws do not collectively meet the 

needs of kin and grandparent caregivers

In fact, kin or grandparent caregivers who take responsibility for a child often face a 

bewildering maze of legal requirements and limitations that differ by state and depend 

on the family’s circumstances (Wallace, 2016). Federal and state public policies are not

designed to assist families who are not part of the child welfare system and therefore 

lack the necessary supports for grandparents and extended families raising children

“U.S. policy has not kept pace with the reality of the family and—as a result—thos

families who are most vulnerable often receive the least support” (Baker, Silverstein, & 

Putney, 2008)

Kinship Families and Grandfamilies Defy Existing Legal Categories

“There is an established legal process when children in the custody of the 

state are placed with relatives but those outside the formal system are left 

to find their own path to stability for the children they have been raising. These 

children often have the same experiences as those in formal foster care, 

the only difference is that a grandparent ‘got there first.’”

-Sharon Olson, grandparent and member of the Advisory Council to Support 

Grandparents Raising Grandchildren

Unlike parents, kin and grandparent caregivers do not have automatic legal rights 

and responsibilities with respect to the children in their care. As noted, only a small

minority of kinship families and grandfamilies (about 133,405 children) are part of the 

foster care/child welfare system, which accords them some specific rights and taxfree subsidies, which vary by jurisdiction. For the rest of the families, gaining legal

recognition as the child‘s primary caregiver involves either petitioning the courts or 

persuading the child’s parents to grant a power of attorney. Some kin and grandparent

caregivers are reluctant to pursue this step. “Many caregivers find it difficult and

intimidating to interact with adversarial court systems, especially when they have to 

bring cases against their own family members” (Annie E. Casey Foundation, 2012

Because each state (and often times each county) has differing processes and 

procedures for defining and recognizing kin and grandparent caregivers, a continuum 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 40

of care arrangements has emerged—with kinship families and grandfamilies who are 

involved with the child welfare system at one end of the spectrum. At the other end of

the spectrum are kinship families and grandfamilies who have no relationship with the 

child welfare system and no legal relationship to the child. Some states have laws that

do offer an alternative legal authority, which can enable kin and grandparent caregivers 

to access much-needed medical services and enroll children in public education in 

their town or county, even if they do not have legal custody or guardianship. Because

not all states have implemented such laws, their availability is inconsistent across the 

nation and even within certain states (Generations United, 2020a)

Variability in legal definitions also exist across states. For example, while some states

are required to give preference to relatives over non-relatives in deciding where to 

place a child, the definition of “kin” varies significantly by state. As a result, access to

child-only grants (i.e., TANF), Medicaid, and other programs can vary by jurisdicti

Clarifying their legal relationship to the child is time consuming and expensive because 

it involves working with legal professionals. Approximately half of the children in kinship

families and grandfamilies live with caregivers who have income below the federal 

poverty level, which was $26,200 for a family of four in 2020. Few of these families

can afford even a single hour of an attorney’s time, not to mention the ancillary costs 

associated with custody applications, such as mediation, psychological evaluations, 

and miscellaneous fees such as filing fees and paying a third party to serve paperwork 

and subpoena financial records

Legal support resources do exist in some jurisdictions. These include legal aid, law school

clinics, Court Self Help, and lawyers for older adults. Yet, many kin and grandparent

caregivers are not aware of these services or do not financially qualify. Others do not seek

legal assistance out of concern for further jeopardizing family dynamics or because they 

expect that the custodial parents will return to care for the children

Without Legal Recognition and Protections, Families are “On Their Own”

“Many times, the grandparent does not have any legal custody due to 

noninvolvement with child welfare. Causing difficulty receiving medical assistance, 

school enrollment. Financial qualifications are different.”

-Response to the RFI

The inconsistency in legal recognition within and across systems and states has 

practical implications that add to the daily stress and challenges experienced by kin 

and grandparent caregivers. Despite the diversity of causes and composition of kinship

families and grandfamilies, one thing they all have in common is the unexpected nature 

of becoming a kinship or grandparent caregiver. Rarely do families have resources to

fall back upon in the face of such a life-changing event
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 41

Amid this sudden life change, they find themselves caring for a child or multiple 

children while learning to navigate a complicated legal system within which they 

have few formal rights and lack the financial resources to obtain access to legal 

representation or seek legal custody. Without a recognizable and consistent form of

legal custody that is flexible enough to meet the needs of these families and their 

circumstances, kin and grandparent caregivers are limited in their ability to access 

the supports and services that could make a meaningful difference in their wellbeing, quality of life, and financial security. At the same time, their day-to-day lives

are complicated by the need to develop workarounds for inconsistent systems and 

outdated requirements. Even seemingly simple tasks like providing permission to

participate in a field trip can be logistically challenging for some families

This is important because a recurring theme of the RFI is that kin and grandparent 

caregivers in these situations were completely unprepared for the stress and 

financial insecurity they were taking on. Most have no idea what legal options exist

in their states and for their unique circumstances, nor do they have time to educate 

themselves on the topic. Instead, they find themselves putting aside their own lives

retirement, work, sometimes other children—to care for a child that is more than likely 

traumatized by removal from the parent(s) and the events that led to that removal

The kin and grandparent caregivers who are not licensed foster parents must house, 

clothe, nurture, feed, protect, educate, and provide for medical care, often entirely at 

their own expense

For additional analysis and discussion on legal arrangements available to grandfamilies 

and kinship families and the challenges they face in this area, refer to the CareCustody - Summary & Analysis webpage at Grandfamilies.or

Education (including Special Education)

“Our school district refuses to accept that kids like him need help as long as they 

do ok in school. Our school district told social security they think he’s ok in school 

so we have been denied social security disability even though his medical [and] 

mental challenges in autism were all diagnosed by medical professionals and are 

all on the SSA [Social Security Administration] website as approved children’s 

disabilities. His last diagnosis states he’ll need lifelong support so who will raise 

him when I’m gone?”

-Response to the RFI 

Education is a critical issue for kinship families and grandfamilies. Many of the children

in these families have special education or behavioral support needs due to the trauma 

they have experienced. Yet many kin and grandparent caregivers struggle to ensure

the children in their charge receive the educational supports they need. Public schools

are often uneducated on trauma and how to manage children with behavior issues
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 42

The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally 

representative sample of children involved with the child welfare system (CWS), 

found that 4% of young children placed in voluntary kinship care with developmental, 

cognitive, or language delays are significantly less likely to have an Individualized 

Family Services Plan as required by the Individuals with Disabilities Education Act, 

compared to 22% of similar children placed in nonrelative foster care (Casanueva, 

et al., 2020). Kin and grandparents often do not have access to or knowledge of th

child’s educational rights. Nor do they have the resources to hire professionals, such

as advocates, counselors, and tutors, who can assist in addressing the educational 

needs of the child. Resources to evaluate and diagnose children exposed to trauma,

fetal chemical exposure, and other issues are not easily accessible

Legal Concerns Shape Education Access

To enroll a child in school, many jurisdictions require the caregiver to have a legal 

relationship to the child in his or her care. However, this practice varies considerably

among states and across the nation (Generations United, 2014). Generally, the kin

or grandparent caregiver needs to show they are responsible and have the legal 

right to make decisions for the child. Some state and school districts allow kin and

grandparent caregivers to use other documents, such as a special power of attorney, 

to enroll a child in school while other states require a “Delegation of Power,” which 

allows the enrollment of the child in school or access to medical care. It can also be

limited to a specific period of time, which limits options for long-term caregivers

Meeting proof of residency requirements, whether through obtaining birth records 

or a legal agreement, such as a power of attorney or legal custody, can be time 

consuming, is often expensive, and a considerable stressor in the lives of kinship 

families and grandfamilies. Due to tensions with birth parents, it can be a challenge

for caregivers to obtain the child’s birth certificate and immunization records

Without actual documentation, consent and access to student information is also 

compromised —including the right to make decisions in a medical emergency 

(Generations United, 2014)

Once kin and grandparent caregivers are able to enroll children in school, other 

challenges remain. For example, a significant proportion of the children need additional

school-based supports and services such as special education or speech and 

language therapy. Others need extra assistance, such as counseling or other social

emotional supports, as they adjust to a new environment. Numerous respondents to

the RFI noted a perceived lack of awareness among educators of the psychological 

needs and a lack of trauma-informed support for children who have been exposed to 

trauma. Furthermore, despite the fact that the Individuals with Disabilities Education

Act recognizes grandparents acting as parents, many kin and grandparent caregivers 

are denied inclusion and the opportunity to advocate for the child in the Individualized 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 43

Education Process if they do not have legal decision-making powers obtained through 

the court system (Generations United, 2020a)

“My grandson has ADHD. Many drug-exposed children do, along 

with learning disabilities.”

-Response to the RFI 

Mental Health Services

Educational needs and mental health are closely intertwined. School is most often

the setting in which children receive mental health supports and children exposed 

to trauma often have additional need for academic assistance. Children who

experience early adverse experiences and youth in foster care, in general, have 

elevated rates of both externalizing (e.g., ODD, conduct disorder) and internalizin

(e.g., depression, anxiety disorders, PTSD) problems, depending on the age an

age of exposures (Hambrick, Oppenheim-Weller, N’zi, & Taussig, 2016). A systemic

review of interventions to address these issues found that some demonstrated 

benefit for both children and caregivers. Developing interventions that are effective

for children in differing circumstances is critical because, left unaddressed, mental 

health issues could have long-term implications not just for the well-being of each 

individual child, but also for society (Gilad & Gutman, 2019). Children who have been

exposed to crime and violence are at greater risk for behavioral problems that affect 

learning. Statistically, they are more likely to come into contact later in life with the

criminal justice system, to engage in substance use, or to experience chronic health 

conditions. Researchers estimate that the cost to the nation of the outcomes of

unaddressed childhood trauma are $496 billion per year (Gilad & Gutman, 2019)

For additional discussion of educational challenges faced by kinship families and 

grandfamilies, refer to the Education - Summary & Analysis webpage on Grandfamilies.or

Grief, Trauma, and Loss

“I’ve had my granddaughter in counseling since age 4, after her father’s 

suicide... She is 14 now and just getting into addressing some major trauma 

issues. The in and out of their birth parents in their lives leaves them with 

many issues. The neglect they receive while in the care of their birth 

parents leaves them with many issues.”

-Response to the RFI 

Silent Witnesses 

While most kin and grandparent caregivers experience immense joy as a result of 

their caregiving role, as noted above, the circumstances that lead to the formation 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 44

of kinship families and grandfamilies are often deeply troubling. Many of the children

have been exposed to substances (often before birth), trauma, violence, and neglect

Some have been silent witnesses to domestic violence, overdoses, incarcerations, or 

witnessed the death of a parent. Some have seen their parents themselves become

victims of crime. The stress associated with such events as death of a parent,

child abuse and neglect, divorce, teen pregnancy, poverty, HIV/AIDS, and adverse 

immigration action each have well-documented impacts on the developing brains 

of children. Gilad and Gutman note in their analysis of the public health costs of

unaddressed trauma in children that, “exposure to crime and violence during childhood 

causes heightened stress levels and overstimulation of specific brain structures, 

which can lead to chemical imbalances in the child’s brain and abnormal neurological 

development” (Gilad & Gutman, 2019)

In 2012, the Attorney General’s Task Force on Children Exposed to Violence declared 

exposure to violence, “a national crisis and a threat to the health and well-being of 

our nation’s children and of our country” (Gilad & Gutman, 2019). That was nearly a

decade ago, and still today, there are few community programs in place to support 

traumatized children and their caregivers and insufficient national awareness of the 

very real need

That is important because with these experiences and stress also come social stigma 

and profound feelings of sadness, shame, and grief. The grief and shame are often

compounded if the child’s parent has died or been incarcerated or if the relationship 

with living adult children is compromised by the need to prioritize the safety and wellbeing of children. The adults in these families also need assistance and education

in parenting children with behavioral or mental health challenges in order to be the 

parent/caregiver they need to be

“The reality is this: the longer someone commits to staying in rehab and sober living 

establishments, the higher the likelihood for successful recovery. If the addicts 

could raise their children, the burden is lifted from grandparents.”

-Response to the RFI 

Responsibility for Children Also a Source of Stress

Caring for children leaves kin and grandparent caregivers with less time and money 

to pursue hobbies and engage in fulfilling activities, which can be a source of grief 

and loss. About a third of grandparents surveyed by the Altarum Institute reported

no longer being able to participate in hobbies they once enjoyed, and a quarter said 

raising their grandchildren put a strain on their relationships with same-aged friends 

(Stanik, 2018)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 45

“I have three grandchildren and all three of them are in several types of therapy. I 

have therapist that come to my home for 3 hours twice weekly and I also have a 

psychiatrist that I have to take them to see every month for therapy and medication. 

Two of my children have IEPs, so I have scheduled meetings with the school. I 

am in constant contact with the school through a Dojo app because of separation 

anxiety, PTSD and other dysfunctional issues due to abuse that the children went 

through before I was finally able to legally rescue all three of them.”

-Response to the RFI 

Respondents to the RFI and members of the Advisory Council also reported that a 

core need is assistance in adapting to a new family structure, specifically determining 

roles in the new family. Caregivers themselves are often facing grief and loss due to

the death of their own child. Loss of their dreams of retirement are added on top of the

stress of caring for a child with trauma. Kin and grandparent caregivers also express a

need for assistance adapting to the role of caregiver, especially later in life

For more on the grief and loss experienced by kinship families and grandfamilies and 

how to provide assistance, refer to the Helping Children and Families with Separation 

and Loss webpage on the Child Welfare Information Gateway website

Housing 

“Some of our members have needed to move into larger homes to be able to take 

in the relatives and this creates a financial burden since affordable housing is hard 

to find that takes in multi-generational families.”

-Response to the RFI 

While there is a small but growing number of housing developments specifically 

designed for grandparents and other relatives around the country, respondents to the 

RFI noted that securing adequate, affordable, and safe housing for their families is a 

key challenge

Financial Issues often Drive Housing Challenges

Financial constraints are a significant factor in limiting the housing options for kinship 

families and grandfamilies. While statistically, a majority of older kin and grandparent

caregivers own their own homes, in reality many of these families struggle to pay for 

expensive home repairs and maintenance, and cover mortgages and increasing taxes

On Tribal lands, American Indian and Alaska Native grandfamily caregivers and other 

residents face much higher incidents of plumbing, kitchen, and heating problems, 

structural deficiencies, and overcrowding than the general population. For those that

are renters, the picture is equally dire; half of kin and grandparent caregivers raising 

grandchildren who rent their homes and have incomes at or below 50% of median 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 46

family income, spend more than 50% of their gross monthly income on rent and could 

benefit from any type of housing assistance. Many senior housing programs do not

allow children and for those that do qualify, waitlists are often lengthy

Limited Access to Assistance Programs 

A number of housing assistance programs are available to qualifying kinship families 

and grandfamilies in the U.S. To date, Housing and Urban Development (HUD’s) Offic

of Policy Development and Research (PD&R) estimates that approximately five million 

American households are receiving housing assistance through the different housing 

programs administered by HUD. However, eligibility for these programs is often

hampered by unclear legal definitions for these families, especially those who lack legal 

custody, and they are not consistently available around the nation. Supportive housing

for older adults or people with disabilities typically does not allow minors, so residents 

may be subject to eviction for bringing children into the household. Not all Regional

Housing and Urban Development Offices, Housing Authorities, and other managers 

of subsidized housing recognize children as part of the caregiver’s household unless 

the caregivers have legal custody. If kinship families gain recognition from subsidized

housing managers, they typically join a long waiting list of families seeking larger units

Caregivers who live in a retirement community that does not allow children may lose a 

significant investment when they are forced to move so that the children may move in 

with them

For caregivers who must relocate to accommodate a growing household, not only 

are larger residences more expensive, the cost of moving can itself be a barrier for 

families who are scrambling to reinvent their household budget to accommodate new 

members. This can prove especially difficult for older families living on a fixed or limited

income, as an overwhelming majority do. Although innovative new supportive housing

developments make a limited number of units available to kinship families, these are 

few and far between (Generations United, 2019)

 “Financial assistance for needy families should be available to all grandparents 

raising grandkids. Affordable housing somehow... we have no Section 8 housing 

per say. We have one complex with reduced rent but at my low income on Social 

Security, I can’t meet their requirement for ratio of income to rent.”

-Response to the RFI 

Child Care

One particular aspect of the financial concerns faced by kinship families and 

grandfamilies was so prevalent in the RFI that it warranted its own category for 

discussion. Child care, particularly the cost of child care, was mentioned 195 times

in the RFI. This is likely because, in addition to limited support from TANF, and limited
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 47

access to housing and nutrition assistance, child care assistance is minimal for families 

that are not part of the child welfare system (Generations United, 2017)

Reliable Child Care is Costly...

Finding affordable child care is a challenge for families across the nation. According

to the Economic Policy Institute, child care accounts for a significant portion of 

the budgets of working families, with some families in the median income range 

spending up to 33.7% of their income on child care. In addition, child care costs var

considerably across the nation. In 2015, a household with one child typically paid

$344 per month in rural South Carolina, while a similar family living in Washington D.

would have paid $1,472 (Gould & Cooke, 2015). For kinship families and grandfamilies,

many of whom live on fixed or limited incomes well below the poverty level, quality 

child care, let alone trauma-informed care, is unaffordable. Even families that receive

support through TANF typically do not receive assistance with child care. The 2011

GAO report examining TANF payments to kinship families and grandfamilies, noted 

that of families receiving TANF, only 5.7% also received assistance with child care (U

Government Accountability Office, 2011). This means that many kin and grandparent

caregivers have limited opportunities to engage in the workforce or access respite 

services, leading to higher risks of poverty and burnout

...And Growing More So

Without changes in policy and increased supports for the families, the situation is 

unlikely to resolve on its own. In response to the COVID-19 pandemic, child care costs

are rising due to closures and increasingly stringent safety protocols for those that 

do stay open. One recent analysis found that operational costs for providers of child

care rose 47% in 2020 (Workman & Jessen-Howard, 2020). These rising costs, if not

addressed, will further negatively affect kinship families and grandfamilies

Food and Nutrition

“We can’t afford fruit, eggs, milk is scarce and there were days we had 

one big meal and just feed the kids.”

-Response to the RFI 

Children need good nutrition to maintain mental and physical health and achieve 

educational success. While some children receive free and reduced-price school

meals, many go to school hungry. Children without adequate nutrition are more likely

to suffer chronic illnesses. They have higher rates of hospitalization than children who

have access to healthy food. They may have difficulty concentrating and are more

likely to repeat a grade (Generations United, 2018b)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 48

Obtaining and maintaining adequate food and nutrition is a challenge for both children 

and caregivers in kinship families and grandfamilies. Nearly a fifth of U.S. childr

(almost 16.7 million) “live in households where they lack consistent access to enough

nutritious food for a healthy life. About 4.5 million (1 in 12) adults age 60 and older ar

now at risk of hunger or food insecurity” (Generations United, 2018b)

Researchers estimate that rates of food insecurity among “multigenerational 

families are at least twice as high as families without resident grandchildren” (Ziliak 

& Gundersen, 2016). This is especially true for the 21% of kin and grandparent

caregivers who are living below the federal poverty line and the 24.9% who have a

disability; both poverty and disability status are risk factors for food insecurity (Ziliak 

& Gundersen, 2016). In fact, the challenge of obtaining adequate food and nutrition

is such a pressing concern for kinship families and grandfamilies that in addition to 

ranking nutrition as a key need, a number of respondents to the RFI wrote moving 

and lengthy descriptions of the daily struggles they face to adequately feed growing 

children

Many respondents to the RFI described how they often sacrifice their own needs, 

including life-saving medication and food, to ensure they can feed the children in their 

care. An advocate described a typical scenario: “Most of the caregivers are sacrificing

their own health to provide food, clothing, and stable housing for those in their care

One client I spoke to doesn’t take all her insulin shots so the children can eat.” For

caregivers who are older adults this has implications for their long-term ability to 

provide care. Older adults who do not have access to adequate and healthy meals

are more likely to get sick and be in poorer health. Inadequate nutrition impedes their

ability to carry out daily activities and can compromise their quality of life, while also 

contributing to rising health care costs (Generations United, 2018b)

SNAP and Other Federal Nutrition Programs

Findings from a nationwide survey conducted by Generations United with funding from 

The Atlantic Philanthropies and AARP, found that 74% of those who sought assistance 

with obtaining nutritious food for their family members in the preceding months, did 

so through government programs like Supplemental Nutrition Assistance Program

(SNAP), the Fresh Fruit and Vegetable Program, the National School Lunch Program, 

the School Breakfast Program, the Supplemental Nutrition Program for Women, 

Infants, and Children, and the Emergency Food Assistance Program (Generations 

United, 2018b). However, some families who qualify for these programs face difficulties

accessing them because of complex eligibility requirements, misinformation about 

those requirements, and complicated application forms. Many families turn to houses

of worship, food pantries, soup kitchens, and emergency shelters for food and 

nutrition, a challenge that has been made more complex by the increasing number 

of families relying on these resources during the COVID-19 pandemic. According to
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 49

Generation United, barriers that can impede access to food assistance programs for 

kinship families and grandfamilies, can include:

■ Income eligibility for programs

■ Exhausted food supplies

■ Hours of operation for food assistance services

■ Age restrictions for access to programs and services

■ Transportation to locations providing food assistance services

■ Location of those services (Generations United, 2018b)

Several respondents to the RFI noted what they perceive as an unfair treatment for a 

segment of society whose unpaid caregiving services collectively saves the country 

approximately $4 billion annually, besides a host of other proven benefits to the children, 

their families, communities/tribes and society. As several respondents pointed out,

licensed foster care families in similar situations are supported, nationally recognized, 

and receive enough financial assistance to feed themselves and the children in their 

care. On the other hand, kinship families and grandfamilies outside the system—the

majority of kinship families and grandfamilies—do not have access to these benefits

For further analysis and a list of recommendations for reducing food insecurity among 

kinship families and grandfamilies, refer to Hunger and Nutrition in America: What’s at 

Stake for Children, Families and Older Adults

Respite Care

One hundred and fifty-six respondents to ACL’s RFI (5.62%) mentioned respite as

an unaddressed need. Because of the round-the-clock nature of caring for children,

especially young children and children with disabilities or exposure to trauma, kinship 

families and grandfamilies need a variety of formal and informal respite options

“We need time to ourselves. Once a week even once a month for time for ourselves. 

Our friends tend to stay away because they raised their kids and are enjoying their 

time. We don’t get that. There needs to be child care available and paid for so we 

can get time to ourselves.”

-Response to the RFI 

Undertaking primary responsibility for raising a grandchild is a life-changing 

commitment, especially when the caregiver is in their older years. It can be especially

challenging for older adults who have not been around children for many years or have 

physical disabilities. In taking on this role, which is almost always an unexpected life

event, caregivers experience physical, emotional, social, legal, and financial challenges 

that they did not face when raising their own children
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 50

Respite provides a temporary break from caregiving responsibilities so caregivers 

can attend to their own medical needs, accomplish critical household tasks, develop 

social relationships, and engage in self-care. For example, many caregivers—40%

of whom are older than age 60—forego medical treatments (especially dental care), 

filling prescriptions, and engaging in self-care to raise a grandchild. Respite can also

rebalance the loss of leisure activities and social relationships that many kin and 

grandparent caregivers experience. That can prevent social isolation and, in turn,

reduce stress and prevent burnout

Many kinship families and grandfamilies cannot afford respite services. Whether they

come in the form of babysitting, daycare, camps, or enrichment classes; safe and 

reliable respite care that is also convenient and accessible is often cost-prohibitive 

for many of these families. This underscores how intertwined most issues are for

kinship families and grandfamilies. For example, even if the activities are affordable,

transportation can be a barrier. For families who have children with disabilities and

challenging behaviors, it can be even more difficult to find a trusted respite provider 

who is able to offer the level of support the child needs

“If I had some financial help, it would allow me to take much needed breaks or at 

least take the worry and stress down a notch for sure!”

-Response to the RFI 

Programs that Provide Respite Care

The National Family Caregiver Support Program and the Lifespan Respite Care 

Program both fund respite opportunities for kinship families and grandfamilies. In

addition, in some states, there are a number of private and state-funded initiatives 

available through Area Agencies on Aging (AAAs). Despite the presence of these formal

services, many kin and grandparent caregivers never take a break. One participant

in the previously discussed grandparents focus group spoke for many when she 

observed, “you can’t just leave your kids with anyone these days.

These barriers to a meaningful break have only been amplified by the COVID-19 

pandemic, which has placed in-person education on hold across the country and led to 

multiple reports of children losing access to special education services and counseling 

support, and as a consequence, experiencing a loss of critical skills and abilities

To learn more about the value of respite care, refer to the ARCH Respite Research 

Consortium webpage on the ARCH website. ARCH also offers a tip sheet for finding

respite care titled 9 Steps to Respite Care for Grandfamilies
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 51

Physical and Mental Health and Health Care 

“Medicaid was difficult to get info on or for my grandchild through social services 

since she was covered under her biological mothers name and for privacy 

purposes, I couldn’t make changes very easily, even with a court order.”

-Response to the RFI 

The financial uncertainty and stresses that kinship families and grandfamilies face 

can leave them vulnerable to poor health outcomes and can also have serious 

consequences on the health of the children in their care. Children in kinship families

and grandfamilies are more likely than children in the population as a whole, to have 

physical, behavioral, and emotional problems, often because of the events that led to 

the formation of the new family (Generations United, 2020a). While mental and physical

health are distinct areas, it is worth noting that an almost equal number of responses 

to the RFI mentioned each realm (105 and 101, respectively). In total, close to 8%

of all RFI responses mentioned the challenges of managing stress, finding time and 

money for self-care, and accessing and managing health care

According to a policy statement by the American Academy of Pediatrics, “the 

growing number of children in kinship care arrangements requires pediatricians to 

be better informed about the unique needs of these children and their families.” For

example, kinship families and grandfamilies are less likely to have appropriate health 

coverage than families led by birth parents. In 2012, 21% of children living in kinship

care arrangements, where there was no biological parent living in the home, were 

uninsured. This was compared to 9% of children who were living with their parent

Today, only 42% of children in kinship families and grandfamilies receive health 

coverage under Medicaid (Rubin, Springer, Zlotnik, Kang-Yi, & Council on Foster Care, 

Adoption, and Kinship Care, 2017). Uncertain guardianship agreements, difficulties

faced by kin and grandparent caregivers in navigating access to health insurance, and 

the tremendous cost of purchasing insurance are just a few of the reasons for the lack 

of health coverage for children in kinship families and grandfamilies

Barriers to Care

Because the vast majority of kinship families and grandfamilies are outside of the child 

welfare system and so many lack a legal relationship to the child, many caregivers face 

barriers when it comes to the medical care of the child. In many cases, the decisionmaking rights are retained by the parents. While emergency care can be provided t

children without a parent’s consent, vaccinations, well-child appointments, and dental 

care can pose challenges for caregivers (Rubin, Springer, Zlotnik, Kang-Yi, & Council 

on Foster Care, Adoption, and Kinship Care, 2017)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 52

While older caregivers in kinship families and grandfamilies receive health insurance 

under Medicare, many of those who are younger than 65 lack coverage and do not 

qualify for Medicaid. Kin and grandparent caregivers are more likely to have an existing

disability. About a quarter of all grandparents responsible for grandchildren live with a

disability according to the ACS (ACS, Table S1001, 2019). As a result, these caregivers

have significant physical health needs of their own, which can be compounded by the 

increased stress of full-time caregiving

In the face of limited finances, many kin and grandparent caregivers forego 

medications or visits to the doctor because of the expenses related to their 

grandchildren. In addition, lack of child care or respite makes health appointments and

hospitalizations difficult, if not impossible for many kin and grandparent caregivers

The health challenges of raising grandchildren are even higher for ethnically and 

culturally diverse populations and those in rural settings. For example, a study of

rural African American kin and grandparent caregivers found higher rates of multiple 

conditions including chronic pain that interfered with sleep and daily functioning, 

mobility issues exacerbated by child care, and the pressure of managing their own 

medical conditions as well as their grandchildren’s. Emotional strain was common as

grandparent caregivers struggled to protect their grandchildren in communities where 

rates of substance use disorders, HIV, and incarceration were high. Caregivers worried

about their mortality and the related consequences for their grandchildren. Chronic

stress, which is linked to a number of poor health outcomes, was self-reported by 

most rural grandparent caregivers

The COVID-19 pandemic has heightened the health vulnerability of kin and 

grandparent caregivers, many of whom are age 60 and older and at greater risk 

if exposed to the virus. Black, African American, and Native kinship families and

grandfamilies have been affected by the pandemic at disproportionate rates, leaving 

children in kinship families and grandfamilies vulnerable to increased trauma and loss 

(Generations United, 2020f)

For additional information on the health and medical needs of kinship families and 

grandfamilies, refer to the Needs of Kinship Care Families and Pediatric Practice policy 

statement released by the American Academy of Pediatrics in 2017

Emergencies and Unplanned Events 

“The system is too [un]wieldy for people to manage it, especially if they are given 

wrong information. I gave up. I have spent thousands of dollars rescuing my 

granddaughter from her mother’s choices.”

-Response to the RFI 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 53

Kinship families and grandfamilies often take on responsibility for a child or multiple 

children in response to a crisis. That means that from the moment they receive the

child, they are in “catch up” mode, trying to learn new ways of parenting, while 

navigating the child welfare system and the byzantine systems of social supports

No Time to Prepare

Any emergency has the potential to disrupt the balance within a family. Whether it is

a public health emergency, a weather event, a flooded basement, or parental death 

or incarceration, becoming the primary caregiver of a child is an unexpected situation 

for which there is little time to prepare. When such situations occur, the physical and

financial limitations of many kin and grandparent caregivers may disproportionately 

limit their ability to manage and respond to the needs of the children who are suddenly 

in their care. For some situations, resources may be readily available, whereas other

crises may require specialized intervention(s)

This vulnerability amid unplanned events was particularly evident during the COVID-19 

pandemic. Kinship families and grandfamilies have also been disproportionately

affected by the pandemic and many have faced the loss of critical services, such as 

special education and respite care, while at the same time experiencing increases in 

their responsibilities and expenses. During the April 2020 meeting, Advisory Council

members discussed the impact of the COVID-19 pandemic on kin and grandparent 

caregivers. It was clear, even only a few months into the public health emergency,

that the spreading virus created challenges for kinship families and grandfamilies 

that were unique. While kinship families and grandfamilies faced many of the same

challenges as other families across the nation, they were at greater risk because 

many of the caregivers are older or have underlying health conditions that make them 

more vulnerable to infection. Many kinship families and grandfamilies found the public

health guidelines difficult to implement. Social distancing was a challenge for families

living in smaller dwellings. Caregivers responsible for young children could not shield

themselves to reduce risk of viral transmission. The closing of schools meant that

families experienced disruptions in much-needed special education and counseling 

interventions. Several Advisory Council members noted that because kinship families

and grandfamilies often live on a limited income, just buying extra cleaning supplies 

and personal protective equipment (i.e., gloves and masks) recommended by publi

health authorities was impossible

In addition, kinship families and grandfamilies are less prepared than the general 

population to deal with the financial shock of sudden unemployment, increased health 

expenses, or the loss of child care and nutritional assistance that schools typically 

provide. Balancing caregiving with employment became particularly challenging during

the pandemic for all caregivers, and it particularly impacted kin and grandparent 

caregivers who are still in the workforce
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 54

In recognition of the risks kinship families and grandfamilies experience in the face 

of any type of unplanned events — including weather emergencies — the Advisory 

Council determined that its first work product would be a COVID-19/emergency 

preparedness resource. Over the ensuing months, Advisory Council members devoted

a considerable amount of effort to gathering content and collaborated on drafting 

text to finalize and publish the COVID-19/Emergency Preparedness Resource Guide 

for Kinship Families and Grandfamilies. This one-of-a-kind resource, posted to the

ACL website, features a collection of three dozen vetted sources of information and 

assistance from federal, state, and local entities that could be of value to any kinship 

or grandparent caregiver during a crisis
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 55

Extended family kinship structures are deeply 

rooted in almost all Native cultures, ensuring Native 

children have several potential caregivers and many 

natural supports (Generations United, 2020c). While

American Indian (AI) and Alaska Native (AN) children 

make up just 1% of all children in the U.S., the

comprise over 8% of all children in kinship families 

and grandfamilies (Generations United, 2020c). When

AI/AN/Native Hawaiian (NH) grandparents and other 

elders take primary responsibility for their grandchildren, they experience challenges 

similar to those faced by other populations. For example, there is a strong need for

legal assistance and financial support, as well as programs and interventions that 

address mental and physical health, education, nutrition, and housing. In one study

American Indian grandparents surveyed received the following services: Medicaid, 

financial assistance, nutritional programs, health services, and services for food, heat, 

and weatherization. Caregivers also identified services that would be beneficial but

were not available in their communities including dental care for the child, and respite 

care for the grandparent (Cross, Day, & Byers, 2010)

Typically, these needs are greater in Native populations because the poverty rate on 

reservations is three times the national rate, and there are fewer services available

The remote nature of many Native communities, combined with aging populations and 

high levels of disability, create a disproportionally high need for caregiving support 

in general. AI/AN/NH families provide approximately 90% of long-term care to older

adults and people with disabilities in their communities—10% more than the general 

V. Supporting Kinship Caregivers in Indian Country: 

Lessons from the ACL Title VI Programs

 “It’s a 24/7 job, you know it’s hard. Sleep with them, get them up in the morning, 

get them ready, like a mom... is supposed to be doing. But like I said, it’s got to 

be done and I’m doing it, the best way I know how. Sometimes I lose it. I just get 

irritated and all that, you know, but that’s age I guess.”

—Grandparent response to Title VI Evaluation

As discussed in Section I of this report, kin and grandfamily caregiving has significant 

advantages over other child care arrangements, particularly foster care with nonrelatives. For Native children, kin and grandparent caregivers offer the additional

benefit of keeping them immersed in their heritage 

and allowing them to “maintain connections to their 

family members, traditions, and cultural identity” (Day, 

Cross, & Farrell, 2011)

For historical context on 

how a legacy of trauma, 

discrimination, and 

unresolved grief continues 

to impact Native American 

kinship families and 

grandfamilies, refer to 

American Indian and Alaska 

Native Grandfamilies: 

Helping Children Thrive 

Through Connection to 

Family and Cultural Identity.
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 56

U.S. population (Institute of Medicine (US) Committee on the Future Health Car

Workforce for Older Americans, 2008)

While Native communities have a strong and proud tradition of caring for family, limited 

access to supportive services means that caregivers often experience more intense 

caregiving and are at greater risk for caregiver fatigue and burnout. In addition, in

the planning and delivery of supportive services to these families, there are important 

considerations that are unique to Native communities that must be recognized and 

addressed to ensure that services and supports are effective, while also clearly 

respecting the sovereignty, culture, and self-determination of each community

In 1978, Congress passed the Indian Child Welfare Act of 1978 (ICWA). ICWA protects

American Indian and Alaska Native (AI/AN) children and families from diversionary 

child welfare practices that separate them from their extended families, communities, 

and culture. Today, in some Native communities, such as Pine Ridge in South Dakota,

58.7% of grandparents living on the reservation are raising their grandchildren. I

the 2006-2008 American Community Survey, AI/AN/NH grandparents represented 

approximately 48,000 of the total number of grandparents raising their grandchildren

Actual figures are likely higher because many AI/AN/NH grandparents are not involved 

with the child welfare system and are reluctant to report their status

“What I need is information on how to help me... with [my grandchildren]. 

I know we got counselors up at the hospital... maybe once a month they 

come in or whatever, but sometimes I need it daily. If they had a pamphlet or 

information on how I can be a better grandparent, because I’m not young like 

I used to be, and I do need my rest.” 

—Grandparent response to Title VI Evaluation

Many of these grandparent caregivers are living with multiple chronic health conditions 

and disabilities and are themselves care recipients of other caregivers. Often multiple

caregivers will coordinate their efforts to support one individual. It is not uncommon

for grandchildren to also serve as caregivers for the grandparents who are raising 

them. While Native populations share a commitment to putting family first and taking a

holistic view of family to encompass neighbors, distant cousins, and close friends, the 

communities themselves are extremely diverse. A service delivery system developed

for the needs of one community may not be replicable in another community

One of the major reasons for this is geography. While federally recognized tribes are

sovereign nations, the tribal reservations are nonetheless affected by the laws and 

regulations of the state within which they are located. This presents special challenges

for tribal entities that are spread over multiple states, where some members live in 

rural areas and others live in metropolitan environments. For example, the Navajo
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 57

Nation has a total population of approximately 331,813 tribally enrolled members

More than half of these people live on the reservation which includes three states: 

Arizona, New Mexico, and Utah. While the nation itself has a rich linguistic and cultural

history of family interconnectedness, each state interprets federal requirements such 

as ICWA differently, which affects how resources can distributed within local and tribal 

communities that straddle state borders

These wide variations in level and type of need and circumstances among Native 

populations must be accounted for when planning the delivery of services and supports, 

especially when resources are scarce. The cost in terms of actual resources and

logistics to deliver a respite program to a tribe in the continental U.S. is lower than th

cost to bring a similar supportive service to a remote population. For example, delivering

services to the Aleut people in Alaska’s Aleutian Islands is made complicated by the 

fact that the community is only reachable by seaplane in winter. The local population

is so small that any extra hands must be brought in from the mainland. To complicate

things further, the local population speaks three different dialects. In addition, supportive

services must also consider the traditional roles of grandparents and elders in Native 

populations. Traditionally, elders are highly revered. While they provide day-to-day car

of children, this is part of the process of cultural and spiritual education; their role is 

“tantamount to nearly that of the supernatural deities” (Iron Cloud-Two Dogs). However,

when grandparents and elders take on primary responsibility for a child, including 

discipline, many experience a difficult process of “role transformation” as they balance 

their new roles as parents with their traditional roles

Finally, because Native populations tend to view family holistically and needs tend to 

be multifaceted, it is not easy to differentiate between services for family caregivers, 

services for kin and grandparent caregivers, and services for grandchildren. This

integrated sense of family can make it difficult for service providers to differentiate, 

measure, and track roles and services for family caregivers, services for kin and 

grandparent caregivers, and services for grandchildren. If a volunteer is providing

chore services at the home of an elder who is the recipient of a family caregiver’s 

support while also serving as the primary caregiver to a minor child, it can be difficult 

for service providers to determine, for the purposes of data collection and evaluation, 

if those chore services are delivered to benefit the elder, the caregiver, or the child

In reality, the entire family likely benefits from such assistance. The data collection

required by non-native service providers parses services in ways that are not intuitive 

for the population, and therefore cultural awareness needs to go beyond service 

provision to the data collection itself

In addition, while all Native American cultures value and prioritize connection and 

harmony among the individual, family, tribe, community, and land, there nonetheless 

exist strong cultural differences between and among individual communities (Tilly & 

Hudgins, 2017)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 58

Title VI of the Older Americans Act 

 “Sometimes I get so mad but then I can’t because those are my kids, they’re my 

grandkids. I can’t... That’s the kind of information I would kind of like to receive, 

even through the mail. How to deal with stress. How to deal with kids of certain 

age. Just like, parenting.” 

—Grandparent response to Title VI Evaluation

The Older Americans Act (OAA) of 1965 established grants for community planning, 

social services, research, and development for older persons. In 1978 the Act was

amended to establish Title VI programs to provide nutrition and supportive services for 

AI/AN/NH. A further expansion added caregiver support services to Title VI, including

support for grandparents and other elders raising children. ACL administers the Title

VI programs with recognition of the strengths and resiliency of AI/AN/NH elders and 

with respect for Native communities’ sovereignty, culture, and self-determination. A

core value of the Native American Caregiver Support Services, as expressed by tribal 

leaders, is that the program should not replace the tradition of families caring for their 

elders. Rather, it provides support that strengthens the family’s caregiver rol

In FY2020, Congress authorized $2.23 billion for ACL under the OAA. Despit

significant need, only 0.5% of that figure (just $10.3 million) was allocated to suppor

Native American family caregivers under Title VI. Currently, ACL oversees 233

individual grants to over 400 tribal organizations across the nation for Title VI caregiver 

services; typical services offered by these grants include: 

■ Information and outreach on topics related to providing care, such as insurance 

coverage, dementia, diabetes, and substance abuse. In 2018, the program

provided approximately 199,495 contacts to provide information on services and 

programs to 42,198 unduplicated AI/AN/NH elders and their families (Administration 

for Community Living, 2018)

■ Access Assistance. Examples include home visits to assess the needs of both

caregivers and recipients of care, help with accessing insurance, Medicare, or 

medical services and referrals to local health clinics or other medical providers

■ Counseling, support groups, and training. In 2018, the program provided 125,480

units of assistance to 18,346 unduplicated AI/AN/NH elders (Administration for 

Community Living, 2018)

■ Respite care, most typically in the form of payments to a respite care worker (often 

a family member) for a certain number of hours per week or per month. In 2018,

the program provided 245,586 units of respite services to 3,280 unduplicated AI/

AN/NH caregivers caring for elders or grandparents caring for their grandchildren 

(Administration for Community Living, 2018)
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 59

■ Supplemental services such as supplies and equipment available through lending 

closets, for example, support them in their caregiving roles

A nuanced understanding of cultural beliefs and values toward caregiving in Native 

communities can assist providers of supportive services to integrate those values 

into services and demonstrate cultural humility and respect. This, in turn, can help

AI/AN/NH caregivers feel their values and beliefs are respected, improving trust, and 

increasing uptake of beneficial supports. Since 2016, an evaluation team has been

conducting a three-year study of ACL’s Title VI programs to better understand how 

tribal organizations operate their Title VI programs and to measure and document the 

impact of the programs

Year 3 of the evaluation focused specifically on caregiver support services, including 

support for grandparent and kinship caregivers. The evaluation used a mix of

information that grantees had already collected, as well as new sources of information 

to describe the implementation and outcomes across services. During site visits held

in March, April, and May of 2019, the evaluation team conducted focus groups and 

interviews to understand caregivers’ experiences with the program, including met 

and unmet needs related to spirituality, social connectedness and isolation, physical, 

mental, and emotional health and wellness, and independence and quality of life. The

evaluation and focus group findings revealed that:

■ Caregiving, including raising grandchildren, is a rewarding, yet challenging, 

experience for members of AI/AN/NH communities. For example, one grandparent

described being concerned about whether her grandson, who struggles with 

behavioral health issues, could pose an unintentional danger to her husband, 

whose mobility and sense of balance was declining. She suggested that caring for

both family members in the same household was stressful

■ Many caregivers do not self-identify as caregivers and as a result may not consider 

themselves eligible for services

■ When services are received through Title VI, they provide important support to 

improve the caregiver’s overall quality of life

■ Many caregivers view their Title VI program services holistically and often do 

not distinguish between services specifically intended to support caregivers in 

comparison to services intended to support elders. For example, Title VI-supported

nutrition and supportive services offered to elders often supported caregivers in 

their caregiving role(s)

■ Many caregivers, including those already receiving some services, were not aware 

of the breadth of services available or had only recently become familiar with the 

program
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 60

The evaluation also uncovered specific challenges faced by AI/AN/NH grandparents 

raising grandchildren. These included the difficulty of “starting all over,” taking on

the role and responsibility of being a primary caregiver for a child or adolescent, at a 

time when many grandparents are in need of greater support themselves, related to 

declining health or mobility. Issues include the time required to care for and raise a

child, the related expense when financial resources may be at a low point, and the fact 

that managing the many tasks needed to raise a child requires energy and agility. Such

tasks include providing meals, supporting routines, helping children with homework, 

attending to grandchildren’s health care needs, and arranging for transportation to 

activities. Some grandparents noted that raising a child in today’s environment is

very different from their own experiences of growing up, as well as compared to the 

experience of raising their own children. For some grandparents, additional factors

greatly intensified these challenges. These included

■ Caring for children who are less independent, including very young children

■ Caring for multiple children at once

■ Caring for children who struggle either with developmental disabilities or behavioral 

health issues, in some cases due to exposure to ACEs

AI/AN/NH families have a strong tradition of cultural emphasis on in-home care, 

respect for elders, and community, yet various forms of historical trauma are significant 

factors in the lives of both the grandparents and grandchildren, and this history shapes 

how decisions are made to access services. Funding and delivering supports that

recognize and respect the dynamic nature of the caregiver/care recipient relationships 

in Native communities is critical for the effective delivery of services to assist them

The final report of the evaluation is anticipated to be released in 2021 and will be 

available on the Services for Native Americans (OAA Title VI) webpage. ACL is

using the preliminary findings to refine program delivery, most recently in developing 

tools that tribal organizations can use to improve data collection and stakeholder 

communication

To review an overview of the Year 3 evaluation, refer to Evaluation of the ACT Title 

VI Programs Year 3 Interim Report. For more information on supporting the needs of

caregivers in Native communities, refer to LTSS Research: Annotated Literature Review 

Caregiver Support in Indian Country. A series of case studies describing AI/AN/NH

caregiver support programs at six locations is available on the CMS website
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 61

VI. Services and Supports Currently Available to Assist 

Kinship Families and Grandfamilies

In 2017, as part of the RAISE Family Caregiving Act, Congress charged ACL with 

developing an inventory of all federal programs supporting family caregivers. The

SGRG Act of 2018 contained a similar requirement to gather information about 

programs and resources to support grandparents raising children

The report shall include— (i) best practices, resources, and other useful 

information for grandparents and other older relatives raising children identified 

under paragraph (1)(A) including, if applicable, any information related to the 

needs of children who have been impacted by the opioid epidemic; (ii) an 

identification of any gaps in items under clause (i); and (iii) where applicable, 

identification of any additional Federal legislative authority necessary to 

implement the activities described in clause (i) and (ii). 

To reduce duplication of effort and enhance fidelity between developed materials, the 

RAISE Family Caregiving Advisory Council and the Supporting Grandparents Raising 

Grandchildren Advisory Council both participated in this effort. Each federal Advisory

Council representative was responsible for surveying their home institution to gather 

specific knowledge important to caregivers and their families and communities and 

the staff and organizations who care for those caregivers. Members also provided

referrals to agencies not represented on either council to ensure a broad collection of 

information. The inventory will support efforts across the federal government while at

the same time avoiding duplication of effort and the creation of gaps in service when 

developing the National Family Caregiving Strategy

As of July 2021, the inventory included information from the following agencies:

■ AmeriCorps

■ Consumer Financial Protection Bureau

■ U.S. Department of Educati

■ U.S. Department of Health and Human Services (10 operating division

■ U.S. Department of Lab

■ U.S. Department of Veterans Affai

The resulting inventory of programs is intended to support all family caregivers, 

including kin and grandparent caregivers. The inventory includes information such as

legislative authority of programs, identified gaps and opportunities, and information the 

public can use to access the programs. The Inventory of Federal Caregiver Support

Programs & Initiatives is available on the ACL website and will be updated periodically
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 62

Best Practices and Evidence-Informed Supports to Assist Kin and 

Grandparent Caregivers

“Our library system sponsors a monthly Grandparent Club, which is a support 

group and sponsors the Grandparent Project which is a series of speakers dealing 

with issues pertinent to our situation.”

-Response to the RFI 

In an effort to identify and document the breadth of emerging best practices to support 

kin and grandparent caregivers, the Advisory Council launched a series of ad hoc 

work groups in October 2020. These work groups reviewed and vetted best practices,

resources, and other useful information about kinship families and grandfamilies 

submitted through the RFI 

The RFI specifically sought information, resources, programs, and/or best practices 

to help kin and grandparent caregivers meet the diverse needs of the children in 

their care, along with similar resources to help them maintain their own physical 

and mental health and emotional and financial well-being. Respondents provided

337 recommended resources. These included 201 state or national programs, 78

publications, 39 research articles, 13 books, and six videos. Members of the Advisory

Council formed a workgroup to review these materials and develop resource lists to 

share with other kin and grandparent caregivers. The workgroup, led by Charlotte

Stephenson, reviewed each of the submitted materials in detail to determine to 

what extent each resource could be of value to a wide variety of kinship family and 

grandfamily stakeholders, including policymakers

The result of that effort, Supporting Grandparents Raising Grandchildren: Resources 

for Consumers and Professionals, includes a list of resources and best practices for 

kinship families and grandfamilies and the professionals who support them

Federal Programs and Resources to Support and Assist Kin and 

Grandparent Caregivers

Kinship Navigators Help Kin and Grandparent Caregivers Forge a 

Path to Success

Multiple RFI respondents, including the Academy of Nutrition and Dietetics, 

cited kinship navigator programs as a recognized and proven best practice 

for supporting kinship families and grandfamilies. Federal law defines kinship 

navigator programs as programs that assist kinship caregivers in learning about, 

finding, and using programs and services to meet the needs of the children they 

are raising and their own needs, and promote effective partnerships among 

public and private agencies to ensure kinship caregiver families are served. 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 63

In its RFI response, the Academy described a successful example of a kinship 

navigator effort underway with SHARE New Mexico, a resource directory on New 

Mexico community health resources, social services, initiatives, and counties.

 “Although there are many government agencies at all levels whose missions are to 

provide support, the reality is that the needed support is not there. I have checked 

online resources and have contacted various agencies but ultimately find myself 

isolated without support.” 

–Response to the RFI

To develop and sustain programs to support kinship families and grandfamilies, an 

understanding of the current landscape of existing support is necessary. A number of

federal agencies provide support and assistance directly or indirectly to kinship families 

and grandfamilies. Yet, finding information about these programs is challenging. A

present, there is no single repository of information on available federal supports and 

services to kinship families and grandfamilies

Congress’ call for a National Family Caregiving Strategy—which is to be informed 

by the inventory of existing federal caregiver support programs—is an important 

step in the realization of a vision where caregivers across the nation can receive the 

assistance they need in a coordinated and efficient manner

The information presented below provides highlights of key federal programs that serve 

kinship families and grandfamilies directly or indirectly. The programs were identified by

members of the Advisory Council, respondents to the RFI, and through the inventory 

development process. They are included in this report to illustrate the diversity of

programs and the potential for gaps or duplication of effort when planning for the 

delivery of supports and services for kinship families and grandfamilies

Administration for Children & Families (ACF)

ACF, a division of HHS, promotes the economic and social well-being of families, 

children, individuals, and communities with funding, strategic partnerships, guidance, 

training, and technical assistance

■ TANF can provide kinship families and grandfamilies with financial support to help 

meet the needs of the children they are raising. States receive block grants to

design and operate programs that accomplish one of the purposes of the TANF 

program. Therefore, these programs vary dramatically from state to stat

■ Kinship Navigator Programs are services that assist kin and grandparent caregivers 

in learning about and accessing programs and resources to meet the needs of 

the children they are raising, to provide help for the family as a whole to safeguard 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 64

stability, and to promote partnerships among public and private agencies. Kinship

navigator programs aim to improve caregivers’ knowledge of services and assist 

them in being able to identify and access the services they need. Some are not

intended to directly provide the services needed by kinship families, whereas others 

do provide direct services and assistance (Child Welfare Information Gateway, 

2019). See sidebar above for an example of a successful kinship navigator

program. According to Generations United, positive outcomes for families receiving

services from kinship navigator programs include:

◆ Safety: Relative caregivers receiving navigator services achieved identified safety 

goals for their families

◆ Permanency: Children in the care of relative caregivers receiving navigation 

services had higher rates of permanency through legal guardianship and 

reunification with parents

◆ Well-being: Results showed that kinship navigator programs were successful at 

ameliorating the needs of grandfamilies (Generations United, 2020d)

■ Child Welfare Information Gateway offers information for families and professionals 

on a range of child-welfare related topics, including family-centered practice, 

child abuse and neglect, abuse and neglect prevention, child protection, family 

preservation and support, foster care, achieving and maintaining permanency, 

adoption, management of child welfare agencies and related topics such as child 

and family assessment, laws and policies, statistics, and related family issues (e.g.

domestic violence and substance use)

■ Administration for Native Americans (ANA) promotes self-sufficiency for Native 

Americans by providing discretionary grant funding for community-based projects, 

and training and technical assistance to eligible tribes and Native organizations. To

maximize resources on behalf of Native communities, ANA partners with related 

programs within ACF and HHS, as well as with other federal agencies and nonprofit 

organizations

■ Office of Head Start manages grant funding and oversees local agencies 

providing Head Start services. Head Start and Early Head Start (HS/EHS)

promote school readiness and provide comprehensive services for children birth 

to age five and their families. Head Start and Early Head Start programs serve

families with low incomes, families experiencing homelessness, and children in 

foster care by providing education, health, and family support services, and by 

engaging parents and families in education and leadership roles in programs

In addition, HS/EHS play a key role in the delivery of early childhood disability 

services, including screening and connecting families to early intervention and 

special education services
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 65

■ Office of Child Care manages ChildCare.gov, a website that provides links to state

or territory child care resources that kin and grandparent caregivers can use to 

search for child care and consumer education information.

Administration for Community Living (ACL)

ACL was created around the fundamental principle that older adults and people of 

all ages with disabilities should be able to live where they choose, with the people 

they choose, and with the ability to participate fully in their communities. By funding

services and supports provided by networks of community-based organizations, and 

with investments in research, education, and innovation, ACL helps make this principle 

a reality for millions of Americans. In addition to supporting the implementation of

the Act, ACL offers the following initiatives that directly and indirectly support kin and 

grandparent caregivers: 

■ The National Family Caregiver Support Program funds a variety of supports that help 

family and caregivers care for older adults in their homes for as long as possible and 

includes supports for grandparents and other older caregivers raising children

■ The Lifespan Respite Care Program works to improve the delivery and quality of 

respite services for caregivers of older adults and people with disabilities through 

coordinated systems of accessible, community-based respite care services for 

family caregivers of children and adults of all ages with special needs

■ RAISE Family Caregiving Advisory Council is charged with providing 

recommendations to the Secretary of Health and Human Services on effective 

models of family caregiving and support to family caregivers, as well as improving 

coordination across federal government programs

■ The National Technical Assistance Center on grandfamilies and kinship families 

(NTAC), created in September 2021, is the first national technical assistance center 

devoted to kinship families and grandfamilies. Through a broad range of technical

assistance and information dissemination, the NTAC measurably increases the 

capacity and effectiveness of states, territories, tribal organizations, and nonprofit 

and other community-based organizations to serve and support members of 

kinship families and grandfamilies

■ University Centers for Excellence in Developmental Disabilities (UCEDDs) offer a 

variety of resources for families and caregivers including guides, videos, webinars, 

and trainings

■ OAA Title VI (Services for Native Americans) provides a range of programs that 

support American Indians, Alaska Natives and Native Hawaiians in the areas 

of nutrition, supportive services for older adults, and caregiver services. The

nutrition and supportive services grants include congregate and home-delivered 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 66

meals, information and referral, transportation, personal care, chores, health 

promotion and disease prevention, and other supportive services. The caregiver

services grants include assisting families in caring for older relatives with chronic 

illness or disability and grandparents caring for grandchildren

■ Aging and Disability Resource Centers Program/No Wrong Door System is a 

collaborative effort with ACL, CMS, and the Veterans Health Administration to 

support state efforts in streamlining access to long-term services and support 

options for older adults and people with disabilities

■ Eldercare Locator is a nationwide service that connects older adults and their 

caregivers with trustworthy local support resources, including meals, home care 

or transportation, or caregiver training, education, or a well-deserved break from 

caregiving responsibilities

■ State Health Insurance Assistance Program provides Medicare beneficiaries with 

information, counseling, and enrollment assistance

AmeriCorps

AmeriCorps operates AmeriCorps Seniors which offers two distinct volunteer programs 

that pertain to kinship families and grandfamilies. These programs are funded through

grants to qualified agencies and organizations for the purpose of engaging adults age 

55 and over in meaningful volunteer service:

■ Foster Grandparent program is an intergenerational program where volunteers 

have the sole mission to help strengthen the education and emotional development 

of children at risk of falling behind in school, many of whom are being raised by 

grandparents

■ RSVP program also supports older caregivers through several focus areas that 

include education, economic opportunity, healthy futures, and veterans and military 

families. For example, RSVP volunteers help renovate homes, tutor students with

disabilities, and help teach money management to those grandparents who might 

be challenged with developing family budgets and securing credit. They also help

educate grandparents on issues around financial exploitation and avoiding fraud 

and scams. Additionally, in the education realm, RSVP volunteers also teach English

to grandparents for whom English might be a second language

Census Bureau

The Census Bureau is the nation’s leading provider of reliable and quality data about 

its people and economy. While the Census Bureau did not participate in the initial

development of the inventory, the agency plays a role in supporting kinship families 

and grandfamilies that is worth noting. According to the Census website, by collecting
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 67

data about the ages of children, household income, disability, and poverty status, 

the agency is able to help communities “enroll eligible families in programs designed 

to assist them.” Communities use census data about how many people within

the community are over a certain age and whether older Americans are caring for 

grandchildren, to fund programs and services targeted to reach older adults through 

the OAA

■ The “grandparents as caregiver’s question” originated with the 2000 Census and 

was transferred to the American Community Survey in 2005. The question asks

whether adults in the household live with their grandchildren under 18 and if they 

are responsible for their basic care. The resulting statistics about grandparent

caregivers help federal agencies understand the special provisions needed for 

federal programs designed to assist families

Centers for Medicare and Medicaid Services (CMS) 

CMS is the agency within HHS that provides access to health coverage to more than 

100 million people through Medicare, Medicaid, Children’s Health Insurance Program 

(CHIP), the Basic Health Program (BHP), and the Health Insurance Marketplace®

■ Medicare is the federal health insurance program for people who are 65 or older; 

certain younger people with disabilities; and people with end-stage renal disease

■ Medicaid provides health coverage for eligible low-income individuals and families, 

children, pregnant women, older adults, and people with disabilities. Medicaid is

administered by states, according to federal requirements. The program is funded

jointly by states and the federal government

■ CHIP provides health coverage to eligible children in families with incomes too 

high to qualify for Medicaid, but who cannot afford private coverage. CHIP is

administered by states, according to federal requirements. The program is funded

jointly by states and the federal government

■ The BHP provides states the option to establish health benefits programs for lowincome residents who would otherwise be eligible to purchase coverage through 

the Health Insurance Marketplace®, providing affordable coverage and better 

continuity of care for people whose income fluctuates above and below Medicaid 

and CHIP levels

■ The Health Insurance Marketplace® provides health plan shopping and enrollment 

services for individuals and families (the individual market), as well as employees of 

small businesses [the Small Business Health Operations Program (SHOP)] through 

websites, call centers, and in-person assistance. A marketplace can be operated

by a state or the Federal Government
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 68

Consumer Financial Protection Bureau (CFPB) 

The CFPB is a U.S. government agency that protects consumers from unfair

deceptive, or abusive practices and arms people with the information, steps, and tools 

they need to make wise financial decisions

■ Managing Some Else’s Money is a series of guides for the millions of Americans 

who manage money or property on behalf of others. The guides help financial

caregivers in three ways: they walk them through their duties, they tell them about 

protecting their loved ones from financial exploitation and scams, and they tell them 

where to go for help

■ Protecting your finances during the coronavirus pandemic has resources to help 

consumers protect and manage their finances during this difficult time

■ Free financial education activities for parents to use with kids to help them build the 

skills to manage money into adulthood

Individuals interested in receiving updates from the Office for Older Americans can 

subscribe at https://www.consumerfinance.gov/consumer-tools/educator-tool

resources-for-older-adults/

Indian Health Service (IHS)

The IHS, an agency within HHS, is responsible for providing federal health services to 

American Indian and Alaska Native (AI/AN) people through the following programs:

■ The Youth Regional Treatment Center (YRTC) program provides education and 

culture-based prevention initiatives, evidence-based and practice-based models 

of treatment, family strengthening, and recreational activities to assist youth in 

overcoming their challenges and recovering their lives to become healthy, strong, 

and resilient leaders in their communities

■ The Substance Use and Suicide Prevention (SASP) program exists to reduce 

the prevalence of substance use and decrease the overall use of addicting and 

illicit substances among AI/AN populations. The program helps ensure access to

comprehensive, culturally appropriate services and promote quality programming to 

address substance use for AI/AN community members. The IHS encourages and

supports cross-system collaboration, the inclusion of family, youth, and community 

resources, and culturally appropriate approaches

■ IHS offers web-based training on Trauma-Informed Care (TIC). IHS TIC training has

been modified and adapted to address the unique experiences, including historical 

trauma, of American Indians and Alaska Natives. Historical trauma is the cumulative

psychological and emotional wounding across generations
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 69

National Institutes of Health (NIH) 

NIH’s 27 Institutes and Centers produce easy-to-understand educational materials 

about health and science for family caregivers. Many of these resources also apply

to kinship families and grandfamilies. The following are a few examples of caregiving

websites across NIH that are relevant to kinship families and grandfamilies

■ The National Institute on Aging (NIA): NIA’s Health Information webpages cover a 

broad range of health topics and include numerous tips and resources on caregiver 

health and for family caregivers

■ The National Institute of Nursing Research (NINR): Health Information pages include 

videos, tear-off pads, resource cards, fact sheets, a provider toolkit, and brochures 

for health care providers and for families with seriously ill children, as part of their 

Palliative Care: Conversations Matter® campaign, aimed at increasing the use of 

palliative care for children and teens living with serious illnesses

■ The Eunice Kennedy Shriver National Institute of Child Health and Human 

Development (NICHD): Health Information webpages offer brochures, booklets, 

reports, and other materials on topics within its research portfolio for different 

audiences, and the Grandparent Videos section features Safe Infant Sleep for 

Grandparents and Other Trusted Caregivers

■ MedlinePlus: A free online health information resource for patients and their families 

and friends, includes information for caregivers

Social Security Administration (SSA)

According to the SSA website, “Social Security is one of the most successful antipoverty programs in our nation’s history.” While the agency did not participate in

the inventory, the agency operates a number of programs that may assist kin and 

grandparent caregivers who qualify

■ Survivors’ benefits are paid to widows, widowers, and dependents of eligible 

workers. This benefit is particularly important for families with children. Some of th

deceased’s family members may be able to receive Social Security benefits if the 

deceased person worked long enough in jobs insured under Social Security

■ Social Security’s Representative Payment Program provides benefit payment 

management for beneficiaries who are incapable of managing their Social Security 

or Supplemental Security Income (SSI) payments. A payee’s main duties are to use

the benefits to pay for the current and future needs of the beneficiary, and properly 

save any benefits not needed to meet current needs
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 70

■ Social Security Benefits for Children are available to qualifying children whose 

parents are disabled, retired, or deceased. Under certain circumstances, a

stepchild, grandchild, step-grandchild, or adopted child can also receive benefits

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is the agency within HHS that leads public health efforts to advance 

behavioral health. Its mission is to “reduce the impact of substance abuse and mental

illness on America’s communities.” SAMHSA offers two specific programs that can

assist kin and grandparent caregivers:

■ The Statewide Family Network Program Grants, administered by the Statewide 

Family Network (SFN) program, provide support to families who are raising children 

with serious emotional disturbance (SED)

■ The National Family Support Technical Assistance Center (NFSTAC) provides 

information to persons and communities across the country who are caring for 

family members with serious mental illness and/or substance use challenges

NFSTAC is led by the National Federation of Families, a family-run organization, in 

partnership with the Partnership to End Addiction, C4 Innovations, SAFE Project, 

and Boston University. The approach of NFSTAC is anchored by the underlying

principle that families play a vital role in supporting their children and are the experts 

regarding their family support needs

■ For providers and organizations that serve American Indian and Alaska Native 

communities, SAMHSA also offers a guide that enhances cultural competence

The American Indian and Alaska Native Culture Card covers regional differences, 

cultural customs, spirituality, communication styles, the role of veterans and older 

adults, and health disparities

U.S. Department of Agriculture (USDA) 

The USDA provides leadership on food, agriculture, natural resources, rural 

development, nutrition, and related issues based on public policy, the best available 

science, and effective management

■ The Supplemental Nutrition Assistance Program (SNAP), also known as “food 

stamps,” is a supplementary program to help an individual or family in buying 

nutritious food. Since SNAP benefits are managed by each individual state

program, applicants should consult the SNAP State Directory of Resources for 

contact information for local SNAP offices
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 71

■ The National School Lunch Program (NSLP) is a federally assisted meal program 

operating in public and nonprofit private schools and residential child care 

institutions. In 2016, the program served 30.4 million children (United State

Department of Agriculture, 2017). USDA also operates a school breakfast program

and a summer food service program for qualifying children

■ The Special Supplemental Nutrition Program for Women, Infants, and Children 

(WIC) offers healthy food, nutrition counseling, and referrals to health, welfare, and 

social services to low-income women and young children. WIC also offers an online

WIC Pre-screening Tool to assist families with determining their eligibility status

■ The Emergency Food Assistance Program provides a variety of nutritious, highquality USDA foods, and makes those foods available to families in need of shortterm hunger relief through emergency food providers like food banks

For more information by state on related programs, browse the Food and Nutrition 

category on Benefits.go

U.S. Department of Education (ED) 

ED offers assistance with obtaining information on educational rights through the 

following programs:

■ Individuals with Disabilities Education Act (IDEA) website brings together IDEA 

information and resources from the Department and grantees that caregivers, 

parents, educators, service providers, or students can use to find information and 

explore resources on infants, toddlers, children, and youth with disabilities

■ Resources for Families and Caregivers — Helping Your Child Become a Reader is a 

curated webpage of federal offices and federally funded clearinghouses that provide 

information on literacy and learning

■ Parent and Family Digital Learning Guide helps caregivers understand how digital 

tools can provide tailored learning opportunities, engage students with course 

materials, encourage creative expression, and enrich the educational experience

■ The Office of Elementary and Secondary Education (OESE) empowers “states, 

districts, and other organizations to meet the diverse needs of every student by 

providing leadership, technical assistance, and financial support.

■ The Center for Parent Information and Resources provides information and 

resources to support families of children with disabilities, and a listing of the parent 

centers throughout the country that receive federal funding to support families at 

the state and community levels
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 72

U.S. Department of Housing and Urban Development (HUD) 

HUD is responsible for national policy and programs that address housing needs and 

enforce fair housing laws. HUD did not participate in the development of the inventory,

but its role in offering multiple programs that provide affordable/subsidized housing 

for low-income families, including kinship families and grandfamilies is important to 

note. In 2019, HUD provided rental assistance to 5.2 million households, of which 68

included children, older adults, and people with disabilities (Center on Budget and 

Policy Priorities, 2021)

■ The Housing Choice Voucher Program (HCVP) or “Section 8” is a recognized HUD 

program. The most notable component of this program is its “portability” feature

which gives recipients the choice of living in any community of their choice across 

the U.S. and the territori

■ The Resources for Tribal Housing webpage on HUD.gov provides an overview of

the Indian Housing Office of Native American Programs (ONAP). In compliance

with the Native American Housing Assistance and Self Determination Act of 1996 

(NAHASDA) (Public Law 104-330), HUD is required to treat Native American tribes 

as sovereign nations entitled to receive direct funding from HUD. As a result, each

tribe designates an organization/entity, which can be a department within the tribe, 

a tribal housing authority with its own Board of Commissioners, or a non-profit 

to administer a housing program on its behalf, these are referred to as Tribally 

Designated Housing Entities (TDHEs)

■ Across the country, HUD is partnering with local housing agencies to address 

the housing struggles of kin and grandparent caregivers by creating affordable 

subsidized housing for kinship families and grandfamilies. Plaza West — a 223-unit

affordable rental community in downtown Washington, D.C., with 50 units in th

12-story complex dedicated to grandparents raising grandchildren — and the 36-

unit grandfamily housing at Pemberton Park, developed by the Housing Authority of 

Kansas City, Missouri, are two key examples

For a detailed list of HUD mortgage, grant, assistance, and regulatory programs 

offered in 2020, refer to Programs of HUD 2020

U.S. Department of the Treasury 

The Treasury office manages currency, government accounts, and public debt. The

Department of the Treasury also enforces finance and tax laws. While it does not offer

any direct programs for caregivers and did not participate in the development of the 

inventory, it is worth noting that the federal tax code does offer tax credits that may be 

available to kinship families and grandfamilies who qualify
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 73

■ The Internal Revenue Service, within the Treasury, offers a fact sheet, Raising 

Grandchildren May Impact Your Federal Taxes, which describes tax benefits 

available to qualifying kin and grandparent caregivers. These include filing status

considerations, possible exemptions, available tax credits, qualifying expenses, and 

information on which tax forms are applicable and how to access them

■ Economic Impact Payments: The Get My Payment tool helps families learn when 

their payment is scheduled to be sent and how it was sent

■ The Treasury Department also offers the Tax Counseling for the Elderly (TCE) 

Program, which may help some kinship families and grandfamilies who qualify in 

completing their tax forms
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 74

VII. Recommendations: What Kinship Families and 

Grandfamilies Need to Thrive

The Advisory Council developed the following recommendations over a year, after 

multiple discussions to uncover the root causes of the challenges described in the 

RFI and in the research data. The Advisory Council’s 22 recommendations will inform

the development of the National Family Caregiving Strategy, which is being developed 

in collaboration with the RAISE Family Caregiving Advisory Council. When fully

developed, the strategy will identify actions that communities, providers, government, 

and others are taking and may take to recognize and support family caregivers. It

will promote greater adoption of person- and family-centered care in all health care 

and long-term service and support settings, increase use of evidence-informed tools, 

information, education, training supports, referral, and care coordination to increase 

support for caregivers and expand access to respite options. Finally, it will increase

financial security and reduce workplace discrimination faced by caregivers, including 

kin and grandparent caregivers

The recommendations are organized into five priority areas to allow for maximum 

integration of federal, state, local, and tribal initiatives to support kinship families and 

grandfamilies. The development of the recommendations is the first phase in an effort

to support kinship families and grandfamilies. Specific actions that must be taken to

address each goal will be outlined in the National Family Caregiving Strategy. Beneath

each recommendation is a rationale statement developed by members of the Advisory 

Council that explains in plain language why that particular recommendation is critical 

to the future well-being of kinship families and grandfamilies

Priority Area 1: Awareness of/Outreach to Kin and 

Grandparent Caregivers

Recommendation 1.1: Increase public awareness and recognition of the unique 

strengths and needs of kin and grandparent caregivers and the importance of 

supporting them while they support the children in their care

Rationale: Kinship families and grandfamilies face unique circumstances and 

challenges. While often faced with stigma and misconception, these families

exhibit considerable strength and resilience. Many of the entities and systems

(e.g., schools, doctors, law enforcement, etc.), that regularly connect with a

support these families, lack the understanding and awareness of the challenges 

they face and how to address them. One of the most effective ways of fighting

stigma and debunking misconceptions is through proactive public awareness 

and education. When stakeholders and the public understand the importance of

supporting kinship families and grandfamilies, they are more likely to be a part of 

the solution
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 75

Recommendation 1.2: Improve outreach to kinship families and grandfamilies to 

help them to identify their critical role as primary caregivers so they seek access to 

appropriate services and supports

Rationale: Those who step in to provide care and support for children, often do 

so without realizing they are becoming a “family caregiver” and, as a result, are 

often not served by child welfare services. Kin and grandparent caregivers often

encounter numerous unanticipated hurdles that quickly can become overwhelming

Many are fearful or mistrustful of the formal system of supports, and very seldom 

reach out to ask for help. To counter this, both traditional and non-traditional

sources of support (e.g., schools, churches, libraries, doctors, dentists) must b

proactively engaged in outreach with information on a wide range of topics

Recommendation 1.3: Increase kinship families and grandfamilies’ awareness of, and 

access to, the full range of available information, services, and supports to help them 

meet their needs and the needs of the children in their care

Rationale: Publicly funded supports are of little use if the people for whom those 

programs are designed never know they exist or how to access them. When kin

and grandparent caregivers step in to care for a child, they often do so with little 

knowledge of the types of programs that are available to support them. One of

the major barriers to accessing supports and services is the lack of consistency 

in the programs, even those within the same state. Bridging the awareness

and information gaps in creative and coordinated ways is essential to ensuring 

that kinship families and grandfamilies can easily locate and access supportive 

services

Priority Area 2: Kin and Grandparent Caregiver Engagement

Recommendation 2.1: Ensure kin and grandparent caregivers are recognized as an 

integral part of the child’s care team, engaged in programs that are family centered, 

and cognizant of the conflicting goals in care

Rationale: Raising a child can take a village. Today, that village might be called

a “care team” and can include extended family, the school system, counselors, 

faith communities, civic organizations and, even, in some instances, the child 

welfare system. Regardless of the makeup of the child’s care team, it is critical

that each member recognize the important role of kin and grandparent caregivers 

as the bridge between the child and that team. They are the “glue” that connect

children to their past and present, which is important to their future well-being

For these reasons, every member of the child’s care team must ensure that the kin 

and grandparent caregivers are recognized and included as equal members of the 

team by putting them at the forefront of the care planning process
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 76

Recommendation 2.2: Increase the use of comprehensive assessments to determine 

caregiver and family strengths and needs when identifying appropriate services for 

kinship families and grandfamilies who are seeking help

Rationale: Kinship families and grandfamilies can often have complex, fluctuating, 

and nuanced needs for information, services, and supports. Many of the kin and

grandparent caregivers are faced with a complex reality in which “they don’t know 

what they don’t know.” A comprehensive needs assessment can be a critical tool

for understanding and effectively implementing a plan of care that benefits the 

whole family. Evidence-based and evidence-informed assessment tools can be

indispensable for understanding the strengths and needs of each family so that 

services provided achieve maximum benefit

Recommendation 2.3: Increase the inclusion of kin and grandparent caregivers and 

young people’s voices in the planning of services by all relevant entities such as child 

welfare, aging, income support, and community-based organizations and service 

providers

Rationale: When community agencies undertake planning and program design, 

a familiar mantra from the likely consumers of those programs is “nothing about 

us without us.” Developing and delivering the right mix of services in the right

ways at the right times, with an eye toward cultural competence and sensitivity 

requires the input and advice of the individuals served. Including guidance, input,

and feedback, from the families they serve, strengthens services and supports 

for kinship families and grandfamilies. Authentic engagement of family voices

promotes trust, encourages buy-in, improves access, and fosters higher levels of 

involvement with services, while reducing the risk of unintended consequences

Recommendation 2.4: Increase the inclusion of the topic of kinship families and 

grandfamilies in the education curricula and programs for health care, social workers, 

child welfare, legal, judicial, education, aging, disability, and related professions

Rationale: Typically, when a child participates in educational, health care, and 

other supportive programs, the child is defined by their parent(s) and the parent(s) 

are expected to represent that child to the various systems. In the case of kinship

families and grandfamilies, there is often a lack of, or few, established policies to 

guide providers so they can adjust accordingly to accommodate children and their 

families. Increased awareness of the unique strengths and challenges of kinship

families and grandfamilies will assist relevant entities with the establishment of 

equitable supportive policies that are rooted in a depth of understanding and lead 

to the implementation of procedures to appropriately support children and their 

families, resulting in the best possible outcomes
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 77

Priority Area 3: Services and Supports for Kinship Families and 

Grandfamilies

Recommendation 3.1: Increase kinship families and grandfamilies’ 

access to information, services, and supports

Rationale: Kinship families and grandfamilies often step up to care for children 

with little warning and may not know what supports or services are available or 

where to turn for help. Most traditional helping systems were not designed with

them in mind and may use exclusive terms like parent or foster parent in their 

outreach, programs, and resource materials. As a result, kinship families and

grandfamilies are often left unaware or unable to access available supports such 

as child welfare services, health care, legal services, respite, counseling, training, 

housing, financial assistance, and food and nutrition assistance

Development and expansion of outreach, referral, and support programs 

specifically designed for relatives, such as kinship navigator programs, can 

improve access to services and supports for kinship families and grandfamilies

Access to supports around the country can be improved further through a 

National Technical Assistance Center on Grandfamilies that will provide training 

and technical assistance on exemplary kinship family and grandfamily practices, 

policies, and programs to systems that serve the target families

Recommendation 3.2: Increase the availability of high quality, setting-appropriate, and 

kinship family and grandfamily-centered respite and child care services

Rationale: For many family and kin caregivers, having a break from one’s 

caregiving duties is essential for good self-care and to prevent stress and burnout

Often called “respite,” this break from caregiving can prove critical for maintaining 

the health of the family caregiver and the integrity of the family unit. Respite for kin

and grandparent caregivers may come in different forms including, but not limited 

to, after school programs, summer or day camp programs, faith-based programs, 

etc. Regardless of the form it takes, or the frequency with which it occurs, respite

programs and services must be of high quality, culturally appropriate, and familycentered to be effective

Recommendation 3.3: Increase the availability and types of culturally competent, 

trauma-informed counseling, training, and education for kinship families and 

grandfamilies, including best practices, model approaches, and evidence-based 

interventions

Rationale: There is an abundance of credible literature and studies showing 

that children raised by kin and grandparent caregivers often have a history of 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 78

trauma. Trauma is defined as any event that is more overwhelming than that which

is ordinarily expected, and can leave the child feeling out of control, terrified, 

worthless, unloved, insecure, and at-risk. Kin and grandparent caregivers often

have little to no understanding of the specific traumas a child has experienced 

and as a result, are unprepared to parent a child with such a challenging history

Providing supports, including counseling, training, and education in traumainformed and culturally competent ways is key to preventing further trauma or retraumatizing the child

Recommendation 3.4: Increase the availability of supports and services that 

specifically meet the needs of the caregiver

Rationale: Increasing the availability of supports and services that address the 

basic needs of kinship families and grandfamilies — nutrition; education; housing; 

emotional, mental, and physical health; and trauma-related issues — will provide a 

foundation for the well-being of the entire family. Over time, this will have a positive

effect on other aspects of the lives of caregivers and children. For example,

being able to maintain hobbies and social engagement, or devote time to attend 

to needs of other family members, can have a protective effect by increasing 

an individual’s capacity to cope with the other stressor they encounter, such as 

finances

Recommendation 3.5: Expand the use of technology as a means of supporting 

kinship families and grandfamilies

Rationale: The continued emergence of new technologies and the required use of 

them to keep pace with the ever-changing landscape of how services are acquired 

and delivered has widened the gap of opportunity for digitally disadvantaged 

families. In addition, many kin and grandparent caregivers are older adults and

more likely to face challenges with understanding or accessing technology. If

kinship families and grandfamilies are technologically disadvantaged, the children 

in their care may not have access to the technology required to be successful 

at school or they may have limited opportunities for social development

Disadvantaged kin and grandparent caregivers may not participate in supportive 

programs that require online access, and where data collection may be required 

for registration. Therefore, their needs remain unknown and unaddressed. Ki

and grandparent caregivers need cost-effective technology, training to use it, 

and information relative to monitoring the appropriate use of technology for the 

children in their care

Recommendation 3.6: Expand the use of volunteers, mentors, and peer-to-peer 

supports as a means for supporting kinship families and grandfamilies, including as a 

possible path to employment or career development
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 79

Rationale: For many kin and grandparent caregivers, stepping into the role 

of “parent” again after many years brings about a host of challenges. In many

cases, these individuals must navigate systems (e.g., schools, health care, lega

assistance, and child welfare programs) that are either new to them or have 

changed since they were parents

Kinship families and grandfamilies can benefit from connections to those with 

lived experience in today’s world who can provide them with an opportunity to 

gain knowledge and connection to others like them. Having robust volunteer,

mentoring, and peer-to-peer programs for these caregivers will help ensure 

they have someone who can assure them that they are not alone; help them 

understand what resources might be available and how to access them; and 

perhaps, even accompany them to school meetings, legal visits, custody hearings, 

and county services

Recommendation 3.7: Improve availability and access to free or affordable quality 

legal and financial information, guidance, and services for kinship families and 

grandfamilies

Rationale: Many times, when grandparents and other kinship caregivers come 

forward to prevent the child from entering the formal child welfare system, they 

need to have a legal relationship established. Kin and grandparent caregivers

caring for children outside the foster care system need access to legal support 

to ensure they have the necessary authority to access supports for the children 

and make certain decisions on their behalf. These caregivers often have poor

inadequate access to quality, affordable legal assistance. Many spend thousands,

even hundreds of thousands, on legal fees, leaving them in debt, often with 

insufficient funds to meet the family’s basic needs, and, even more often, reduced 

savings to meet unexpected financial shocks. Many opportunities exist to expand

and improve the availability of legal and financial services, supports, and guidance 

to properly address these critical priorities

Recommendation 3.8: Improve child welfare system approaches to better prioritize 

and support the placement of children with relatives when they cannot remain with 

their parents

Rationale: Some child welfare agencies do not have strong systems in place 

to conduct outreach to identify and prioritize relatives for children who must be 

removed from their parents’ homes. As a result, children are unnecessarily placed

with unfamiliar foster parents where they are more likely to lose connections to 

their siblings, extended family, cultural identity, and community connections

Improving child welfare system approaches to engaging and supporting kinship 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 80

families and grandfamilies will result in better outcomes for both caregivers and 

children. Child welfare systems must improve their outreach, engagement, and

supports to relatives by: leading their agencies with a “kin-first” philosophy; 

developing written policies and protocols that reflect equity for children with kin 

and recognize their unique circumstances; identifying and proactively engaging 

kin for children at every step; creating a sense of urgency for making the first 

placement a kin placement; prioritizing kin licensing; supporting permanent 

families for children; and creating a strong community network to support kinship 

families and grandfamilies

Priority Area 4: Financial and Workplace Security for Kin and 

Grandparent Caregivers

Recommendation 4.1: Promote policies that prevent kin and grandparent caregivers 

from being financially disadvantaged by their caregiving responsibilities

Rationale: Most kin and grandparent caregivers come to their roles unexpectedly 

and were not planning to step in to raise a child in their later years. Many may

also be living on a fixed income and do not have access to the information or 

knowledge of the programs that could help them to obtain financial support. As

a result, they often spend their retirement savings to meet the children’s daily 

basic needs and legal fees associated with getting legal custody of the children

When this happens, both the caregivers and children experience adverse impacts

Policies that provide financial support for kinship families and grandfamilies should 

not require them to spend any life savings they may been able to acquire before 

accessing supports

Recommendation 4.2: Advance the development and broad adoption of workplace 

policies, flexibilities, and practices that recognize kinship family and grandfamily 

responsibilities as a fundamental part of each worker’s life and support public-private 

partnerships that enable scalable solutions

Rationale: Many kin and grandparent caregivers remain in the workforce while 

at the same time juggling the daily demands of raising children. These caregivers

should be given the opportunity to benefit from the same workplace policies and 

protections as are in place for parents. Meaningful, flexible policies and practices

in the workplace can afford kin and grandparent caregivers the information, tools, 

and resources they need to balance their responsibilities, thus allowing them to 

remain in the workforce and maintain their financial stability

Recommendation 4.3: Increase the availability and use of tailored resources that 

kinship families and grandfamilies can use to make informed financial decisions and 

plan for future financial needs
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 81

Rationale: Kin and grandparent caregivers often express concerns about their 

own personal financial situations and the future financial security of themselves 

and the children in their care. Many have persistent concerns about how to meet

the costs of health care, health supplies/equipment, school supplies, housing, and 

other needs of the children. Caregivers have their own financial needs, and that

may include supporting other family members. Kin and grandparent caregivers

need a range of information and resources to support sound financial decisions 

and future planning for themselves and the children in their care

Recommendation 4.4: Ensure that kinship families and grandfamilies have the 

resources they need to engage in advance planning so that they may provide for 

children in the event of illness or incapacity

Rationale: Caregivers are often so busy meeting the children’s basic needs that 

they do not have the time, nor do they give thought to making the necessary 

legal arrangements for themselves or the children in their care. Without adequate

and sound legal protections, the children may end up in the foster care system

This issue is further complicated and made more urgent when the children have 

disabilities. Ensuring the availability of, access to, and support for developing

legal and financial arrangements are critical tools for protecting the future of the 

caregiver and children alike

Priority Area 5: Research, Data, and Evidence-Supported Practices

Recommendation 5.1: Establish a national approach for obtaining, analyzing, and 

disseminating relevant data on kinship families and grandfamilies

Rationale: There is currently a lack of uniformity and comprehensiveness with 

respect to available data representing kinship families and grandfamilies. This

is largely because such data is only collected on those families that come into 

contact with child welfare or other similar agencies. There is little data collected on

the kinship families and grandfamilies that are unknown to the foster care system

Without sufficient and reliable data on these families, developing and administering 

programs of support that are of the proper scope will remain elusive at best

For this reason, establishing a national mechanism for obtaining, analyzing, and 

disseminating data is needed

Recommendation 5.2: Increase, support, and sustain research and development, 

including adequate investments for evaluation of programs that support kinship 

families and grandfamilies
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 82

Rationale: Few of the systems serving kinship families and grandfamilies were 

designed with these families in mind. Developing programs specifically tailored to

the needs of kinship families and grandfamilies is a relatively new practice. Many

programs that are serving them have been pieced together from varied funding 

sources without adequate resources to properly evaluate their efficacy. As a

result, there is a dearth of research on effective programs. Many of the available

federal and local funding streams for kinship family and grandfamily supports 

required programs to be evidence-based. Investments in research and evaluation

for kinship family and grandfamily services will provide a pool of evidence-based 

programs and learning to inform model practices. This will better ensure that

benefits, services, and supports are effectively meeting their needs, and that they 

will have access to ongoing funds to sustain them

Recommendation 5.3: Increase the promotion, translation, and dissemination of 

promising practices, model approaches, evidence-informed and evidence-based 

practices to support kinship families and grandfamilies

Rationale: Effective supports and interventions for kinship families and 

grandfamilies is often dependent on translating the research into real-world 

settings. Effective interventions require that such efforts must be multi-component

and address both the pragmatic and the emotional elements of caregiving

Working with diverse communities to develop services and models that best meet 

their needs, while expanding and replicating promising practices that are personand family-centered are critical components. Building on evidence-informed

services for caregivers is fundamental to helping organizations scale up practices 

and supports that are proven to be impactful and cost-effective
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 83

VIII. Conclusion

Grandparents and other elders connect us to the past and prepare us for the future

When parents cannot care for children, the wisdom, experience, and selfless loving 

care of grandparents, close relatives, and family friends forms a safety net for children 

who would otherwise find themselves living with people they do not know

The nation owes an immeasurable debt of gratitude and support to the millions of kin 

and grandparent caregivers across the nation who have primary responsibility for their 

grandchildren on a day-to-day basis. The U.S. Census Bureau estimates that the

are 2.7 million children in the care of grandparents (U.S. Census Bureau, 2019). 

true number—when taking into account the aunts, uncles, godparents, family friends, 

and all the people who are responsible for children without realizing they are in fact 

“caregivers”—is likely many times higher

The number of children who cannot remain with their parents is increasing and 

expected to continue to do so in the future. Kinship families and grandfamilies are

the solution to a growing national problem. Instead of placing children in the foster

care system, grandparents can and do step in to nurture, financially support, and 

provide primary care for the child. This approach works because kin and grandparent

caregivers have a different set of strengths than a foster parent would provide. More

importantly, it works because they know and love the children in their care

While the child welfare system is increasingly relying on kinship families and 

grandfamilies to raise the children, grandparents and other relatives are less likely 

than non-related foster parents to receive supports and services (Generations United, 

2017). Placing children with people who know and love them enables children to

stay in their communities and allows families to continue to grow and learn together

It keeps families together and ensures children grow up in homes where they feel 

loved. However, taking on full responsibility of a child, or multiple children, frequently

comes at great personal cost to the caregivers. Even though some financial supports

are available, the majority of kinship families and grandfamilies are not able to access 

them (Annie E. Casey Foundation, 2012). Placing children in the loving arms o

friends and family should not cause the person who takes in those children to have 

to choose between the child and health, well-being, putting meals on the table, or 

obtaining basic necessities

Kinship families and grandfamilies also face significant barriers when it comes to 

navigating confusing and sometimes conflicting legislation and accessing legal 

assistance and education (including special education). While they grapple with these

challenges, they must also navigate the grief, trauma, and loss they experience, often 

related to the reasons they came to be part of a kinship family and grandfamily, while 

at the same time ensuring that the children in their care have adequate nutrition and 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 84

housing. This is a significant burden for people who would otherwise be looking ahead

to what are often referred to as the “Golden Years.”

On top of this, kinship families and grandfamilies contend with significant hurdles when 

it comes to accessing quality health care, finding child care, taking care of their mental 

health and need for self-care, and simply finding time for a meaningful break. Many of

these families live lives so precarious a single unplanned event or emergency can be 

disastrous to their well-being

This is a growing problem. Annie E. Casey Foundation has estimated that th

percentage of children in the care of grandparents has held at 4% since 2010, even 

as the population of children has increased. The need to support kinship families and

grandfamilies will not resolve unless the nation takes a holistic approach to increasing 

awareness, reforming policies that marginalize kinship families and grandfamilies, and 

increasing access to culturally appropriate services and supports — including traumainformed care

The Advisory Council came together in late 2019 to address the multiple and often 

overlooked challenges faced by kinship families and grandfamilies. Their initial goal

was to develop a set of recommendations to improve awareness of and services and 

supports for this vulnerable population. The recommendations they developed after

an extended investigative process cover five priority areas that allow for maximum 

integration of federal, state, local, and tribal initiatives to support kinship families and 

grandfamilies. These include awareness and outreach, caregiver engagement, services

and supports, financial and workplace security, and research, data, and evidencebased practices. Taken together, they are a critical first step in better supporting the

people who selflessly step in to raise a child

The Advisory Council’s 22 recommendations will inform the development of the 

National Family Caregiving Strategy, which is being developed in collaboration with 

the RAISE Family Caregiving Advisory Council. When fully developed, the strategy will

identify actions that communities, providers, government, and others are taking and 

may take to recognize and support family caregivers. It will promote greater adoption

of person- and family-centered care in all health care and long-term service and 

support settings, increase use of evidence-informed tools, information, education, 

training supports, referral, and care coordination to increase support for caregivers 

and expand access to respite options. Finally, it will increase financial security and

reduce workplace discrimination faced by caregivers, including kin and grandparent 

caregivers

The members of the Advisory Council are grandparents and professionals who 

have devoted their lives and careers to improving outcomes for kinship families and 

grandfamilies—some are both. In 2020, when a pandemic hit, many members of
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 85

the Advisory Council numbered among the populations most vulnerable to infection, 

long-term complications, and even death. Yet, in the face of these terrible challenges,

the Advisory Council adapted and overcame, continuing their work remotely without 

missing a beat

Through this important work, the Advisory Council has demonstrated the very resilience, 

grit, and personal integrity that makes kin and grandparent caregivers the ideal group 

to raise children who cannot remain with their birth parents. It is time for the nation to

honor the self-sacrifices of kinship families and grandfamilies by doing all we can to 

identify and deliver services and supports that can help them succeed and thrive
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 86

Endnotes

1 The Advisory Council recognizes that universal language to describe the circumstances of Kinship 

Families and Grandfamilies does not exist at this time. For more information, refer to Kinship

Caregivers and the Child Welfare System

2 The Current Population Survey/Annual Social & Economic Supplement (CPS/ASEC), has a variable 

(parent indicator) that the American Community Survey (ACS) does not have, which allowed us to 

identify children who did not have either parent living in the household (see page 55 in GAO-20-

434, CHILD WELFARE AND AGING PROGRAMS: HHS Could Enhance Support for Grandparents 

and Other Relative Caregivers)

3 2019, US Census Bureau July 1, 2019 Estimates. United States Census Bureau. July 20

4 2019: ACS 5-Year Estimates Grandchildren Characteristics, Table S1001, United States 

Census Bureau

5 2019: ACS 5-Year Estimates Grandparent and Grandchildren Characteristics, Table S1002, United 

States Census Bureau
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 87

Acronyms and Abbreviations 

■ AAA: Area Agency on Aging

■ ACEs: Adverse Childhood Experiences

■ ACF: Administration for Children & Families

■ ACL: Administration for Community Living

■ ACS: American Community Survey

■ AFCARS: Adoption and Foster Care Analysis and Reporting System

■ AI: American Indian

■ AN: Alaska Native

■ ANA: Administration for Native Americans 

■ ASPE: Office of the Assistant Secretary for Planning and Evaluation 

■ BHP: Basic Health Program 

■ CFPB: Consumer Financial Protection Bureau

■ CHIP: Children’s Health Insurance Program 

■ CMS: Centers for Medicare & Medicaid Services

■ CPS: Child Protective Services

■ ED: U.S. Department of Educati

■ GAO: Government Accountability Office

■ HCVP: Housing Choice Voucher Program or “Section 8”

■ HHS: U.S. Department of Health and Human Servic

■ HRSA: Health Resources and Services Administration 

■ HUD: U.S. Department of Housing and Urban Developme

■ ICWA: Indian Child Welfare Act

■ IDEA: Individuals with Disabilities Education Act 

■ NAHASDA: Native American Housing Assistance and Self Determination Act of 

1996 (Public Law 104-330), 

■ NFCSP: National Family Caregiver Support Program

■ NFSTAC: National Family Support Technical Assistance Center

■ NH: Native Hawaiian

■ NIA: National Institute on Aging 

■ NICHD: The Eunice Kennedy Shriver National Institute of Child Health and Human 

Development 

■ NIH: National Institutes of Health

■ NINR: National Institute of Nursing Research

■ NSLP: National School Lunch Program 
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 88

■ NTAC: National Technical Assistance Center on Grandfamilies and Kinship Families 

■ OAA: Older Americans Act of 1965, as amended

■ OESE: Office of Elementary and Secondary Education

■ ONAP: Office of Native American Programs 

■ ONC: Office of the National Coordinator for Health Information Technology

■ OPRE: Office of Planning, Research, and Evaluation

■ PTSD: Post-traumatic stress disorder

■ RAISE Act: Recognize, Assist, Include, Support, and Engage Family Caregivers Act 

■ RFI: Request for Information

■ SAMHSA: Substance Abuse and Mental Health Services Administration

■ SED: Serious emotional disturbance

■ SFN: The Statewide Family Network

■ SGRG Act: Supporting Grandparents Raising Grandchildren Act 

■ SUSP: Substance Use and Suicide Prevention 

■ TCE: Tax Counseling for the Elderly

■ TDHE: Tribally Designated Housing Entities

■ TIC: Trauma-Informed Care 

■ UCEDDS: University Centers for Excellence in Developmental Disabilities 

■ WIC: Special Supplemental Nutrition Program for Women, Infants, and Children 

■ YRTC: Youth Regional Treatment Center 

■ SNAP: Supplemental Nutrition Assistance Program

■ SSA: Social Security Administration

■ TANF: Temporary Assistance for Needy Families

■ The Advisory Council: The Advisory Council to Support Grandparents Raising 

Grandchildren 

■ USDA: U.S. Department of Agricultu
Supporting Grandparents Raising Grandchildren (SGRG) Act Initial Report to Congress Page 89

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