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The case studies provide an in-depth look at policies and practices affecting children in TANF child-only cases with relative caregivers in five states. Complementary information sources include discussions with professionals in TANF agencies, child welfare agencies, aging services offices, and relative caregivers, as well as reviews of program documents and case record abstractions. Together, these diverse perspectives provide a comprehensive picture of how the TANF program supports kinship care, and areas of potential unmet need.
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Case study is an ideal methodology when a targeted, in-depth investigation is needed (Feagin, Orum, and Sjoberg, 1991). Case studies are a useful tool in exploratory analysis because they are designed to bring out the details from the viewpoint of the participants through the use of multiple sources of data.
The study team used a multiple-case, explanatory-exploratory methodology to investigate policies, services, and well-being for relative child-only cases. The explanatory strategy addresses "how" questions comparing the well-being of children in TANF child-only cases with relative caregivers with other children in relative care and to children in TANF cases with parents. The exploratory strategy addresses "what" questions regarding policies and programs affecting children in TANF child-only cases with relative caregivers, as well as service needs and services received by children in TANF relative caregiver child-only cases.
While case study research is not sampling research, selecting cases must maximize what can be learned with available time and resources. Study staff reviewed data on caseload size, stability, and level of attention to relative caregiver cases as documented in state TANF plans or reported by regional staff. Staff selected states for the in-depth analyses based on
Based on these factors, five states were selected to participate in this study: Louisiana, Maryland, Oklahoma, Washington, and Wisconsin. Within states, study staff selected two counties for examination, based on
The study team used multiple data sources and data collection approaches in a triangulated design to increase confidence in findings. Table 4-1 summarizes the data collection approaches, data sources, and the strengths and weaknesses associated with each.
| Data Collection Method | Data Source | Respondent/Material | Potential Strengths/Weaknesses |
|---|---|---|---|
| Individual Discussions | State personnel |
|
Strengths
Weaknesses
|
| Group Discussion | County personnel |
|
|
| Record Abstraction Document Review |
County records State records County records |
|
Strengths
Weaknesses
|
| Focus Group | County clients |
|
Strengths
Weaknesses
|
The study team developed individual and group discussion guides, templates for document review, and record abstraction guides based on findings from the comprehensive literature synthesis and the secondary data analysis. Researchers structured discussion guides to ensure consistent data collection while allowing researchers enough flexibility to tailor discussions to respondents' expertise and pursue emerging ideas. RTI's Committee for the Protection of Human Subjects approved all data collection materials and procedures prior to data collection.
The study staff conducted on-site data collection between October and December 2003. Two-person teams shared responsibility for leading discussions, abstracting data, and taking notes using topically organized forms. The study team held debriefing meetings after each site visit to review findings and identify any needed follow-up or modifications to procedures.
Miles and Huberman (1994) have suggested alternative analytic techniques for case studies, including using arrays to display the data, creating displays, tabulating the frequency of events, ordering the information, and other methods. The analysis process used a combination of approaches to build a description and explanation of current practices, policies, and initiatives regarding services for children in TANF relative caregiver child-only cases. To ensure that the analysis was of high quality, staff used all relevant evidence, examined all rival explanations, and used their knowledge and experience to the maximum advantage in the study.
The first step of data analysis was to develop and describe critical themes streaming through the data across states and across discipline (i.e., contrasts between TANF and child welfare). Study staff used this analysis to develop key topics for discussion in this report. The second step was to compare the five sites based on the critical themes identified. Researchers tested hypotheses within and across states to identify differences in policy and practice, factors contributing to these patterns, and effects for children and relative caregivers.
Quotes from informants and focus group participants have been edited for brevity and clarity. Statements that are negative in tone that cannot be assumed to represent practice in a given state are included without attribution to the site.
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As depicted in Section 2, child-only cases have been growing in proportion since the enactment of PRWORA in 1996. Characteristics of the child-only caseload and their relative caregivers varied among the states participating in the case studies.
Children
The most recent national data on children in child-only cases comes from the Fifth Annual TANF Report to Congress (DHHS, 2003) and is based on data collected between October 2000 and September 2001. Table 4-2 summarizes these nationally collected data for the five states.
| State | Number of Children in TANF Child-Only Caseload | Children in Child-Only Cases with No Parent in Household | Percent of Children in TANF Child-Only Relative Care Who Live with Grandparent | |
|---|---|---|---|---|
| Number | Percent of All Children in TANF Child-Only Caseload | |||
| Louisiana | 21,770 | 9,818 | 45.1% | 72% |
| Maryland | 18,207 | 13,328 | 73.2% | 68% |
| Oklahoma | 11,081 | 6,172 | 55.7% | 71% |
| Washington | 29,320 | 14,572 | 49.7% | 62% |
| Wisconsin | 21,878 | 9,823 | 44.9% | 56% |
| U.S. Total | 1,391,263 | 517,550 | 37.2% | 59% |
| Sources: Fifth Annual TANF Report to Congress (DHHS, 2003). | ||||
| "A relative typically comes in and states that they have the child because
of [parental] drug use or incarceration. Most of the time they don't know
the whereabouts of the parent."
TANF Eligibility Worker, Maryland |
While specific statistics were not available, all five states involved in the in-depth analysis consistently reported parents' drug use and incarceration as the primary reason leading to placement out of the home. Oklahoma informants reported that most of the child-only cases come from the relative taking care of the children because a mother is incarcerated. Additionally, informants in Oklahoma and Washington noted the prevalence of methamphetamine laboratories and substance abuse as a primary reason for relatives being called upon to care for the children of their kin. Often, parents will approach a relative for temporary placement while they seek substance abuse treatment or rehabilitation; however, these persons often relapse into substance abuse and the children remain in the care of the relative.
Caregivers
All five states participating in the in-depth analysis reported that children in child-only relative caregiver cases were most likely to reside with a grandparent. Based on data from the Report to Congress (DHHS, 2003), this proportion ranged from 56 percent in Wisconsin to 72 percent in Louisiana, as shown in Table 4-3. Aunts were reported as the second-most common relative caring for a child in a child-only relative caregiver case. In the record review of 148 cases child-only cases with relative caregivers across all 5 states, researchers identified 44 cases where relatives other than grandparents were serving as caregiver, although this review is not representative of all cases.
While all states thought that the majority of their grandparent relative caregivers were "younger grandparents," few states had specific statistics regarding the average or mean age of the grandparent caregiver. Washington State reported the median age of relative/kinship caregivers to be 50 years, compared to 34 years for ineligible parents and 40 years for unrelated caregivers (Washington State DSHS, 2003). The age of these grandparents and other relative caregivers is significant because it indicates that many relative caregivers are working. As such, they are in need of support for day care and after-school care services. Their work performance may also be affected by difficulties finding affordable day care or children's behavioral problems that interfere with their day care or school attendance.
In addition to caregiver relationships, the circumstances leading to relative caregiver arrangements were also reported to vary across states. Louisiana reported that few kinship care cases are involved with the child welfare system, perhaps because most children living with relatives come to live with the relative before child protective services steps in. Therefore, the majority of their cases were TANF cases with minimal involvement with child welfare. Paula Brown, Kinship Care Coordinator for Wisconsin, estimates that 20 percent of relative care cases are court-ordered (in child welfare agency custody).
By contrast, Oklahoma reported that many of their relative caregivers are involved with child protective services and receiving child-only TANF as interim support while they work to become licensed foster parents. Informants in Maryland and Washington reported that approximately 50 percent of their child-only relative caregiver cases are referred to the TANF office and are involved in child protective services. Note that these are estimates, and that TANF agencies do not track child welfare involvement within their case loads.
Stability of placement was identified as a strength of relative caregiver arrangements. Louisiana reports that children in child-only cases often remain with the relative caregiver until they are 18 years old. The Child-Only TANF case manager in Pottawatomie County in Oklahoma reported that child-only cases "remain open until the child turns 18 or the relative closes the case." Maryland and Washington reported a transitional program for children 16 through 18 years of age receiving child-only benefits.
| "Parents are able to come back, damage the family unit, leave and come
back again."
Family Investment Case Manager, Maryland |
Respondents from all five states identified concerns regarding parental visitation and its impact on the family. While child-only TANF households are not intended to include the child's parents, TANF workers acknowledged they had little control over this situation. TANF eligibility workers in Louisiana referred to the situation as a "revolving door on the home." The Puyallup County Service Officer Administrator in Washington State reported that "a grandparent — who loves their own child — sends children home with the parent." The State of Wisconsin is working to address this situation by requiring the caregiver to sign a kinship care agreement specifying the terms for parental visitation.
| "Children would rather live with their parents and are dealing with questions
like 'why am I not living with my parent' and 'where do [my parents' live."
Kinship Care Coordinator, Wisconsin |
Children
Across all five states participating in the in-depth analysis, TANF eligibility workers and child welfare workers expressed concern for the well-being of children in TANF child-only cases with relative caregivers. Service providers and relative caregivers described the reasons that children entered care in nearly identical words, "drugs, mental illness and homelessness," offering numerous anecdotes of children experiencing maltreatment. A TANF eligibility worker in Louisiana stated that "nothing deals with the quality of life for these children." While grandparents offer some stability, many children are torn between the loyalty they feel toward their parent and their grandparents. A TANF eligibility worker in Oklahoma stated that "children sense the complicated relationships between caregiver and parent." Addressing the moderation of benefits, a TANF eligibility worker in Oklahoma noted that "the nurturing that would come from the mother will be missed, but can be matched by the nurturing from a relative."
Many informants noted the need for counseling to help children deal with the experience of separation from their birth parents. Child welfare workers in Washington State stated, "children need counseling. They are having problems in school and at home and the wait time for services is 3 or 4 months." Another Louisiana TANF worker stated, "separation from parents can be difficult for children to deal with. They need counseling and are not receiving any." The State TANF Director in Maryland noted that "these children need more than medical and cash assistance — they need extra therapy to know how to adapt."
The permanent nature of these cases was also discussed as having an impact on the well-being of the child. As the Kinship Care Coordinator in Wisconsin stated, "It becomes too easy to just leave the child placed with the relative, but that placement often does not offer the child any type of closure like adoption or reunification." While the parents involved with most of these cases do not express a desire for reunification, this remains an issue for the children in these child-only cases.
Finally, while the general feeling of most persons participating in the in-depth analysis was that the system is fortunate to have relatives willing to care for their kin, some concern was expressed regarding categorically accepting a relative as the best placement option. As the Division Manager for Social Services in Sheboygan, Wisconsin, stated, "For us to blindly trust that the relatives are handling this well is nave on our parts." Case workers across the five states noted that relative caregivers themselves may have a history with the child welfare agency. While this issue was discussed as a concern, a social worker in Wisconsin stated, "there seems to be the ability of the caregiver to do a better job of caring for a child on the second go round."
Caregivers
| "[Grandparents] are being asked to take on the responsibility of raising
children in a different era." Child Welfare Worker, Washington |
While children in child-only relative caregiver cases are dealing with the loss of a parent and previous traumatic experiences, caregivers often face substantial challenges as well. "Older people don't know how to deal with the social and behavioral problems that many of these children have," stated a Louisiana TANF eligibility worker. These problems are complicated by relative caregivers' social isolation. They have little contact with others raising young children, and childrearing demands may limit their contact with their own support network. Informants also pointed out that grandparent caregivers are often dealing with problems related to their own children's substance abuse or mental illness, in addition to raising their grandchildren.
Compounding the emotional issues of raising relative children with multiple mental and behavioral issues, many relative caregivers are also dealing with physical or functional limitations of aging. Some caregivers are suffering from disabilities keeping them from working or driving, while others are just challenged by the day-to-day care of an infant or a teenager. As one relative caregiver in Wisconsin stated, "you find yourself saying I can't do this anymore, I can't care for these children if it is going to disrupt my life."
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Section 2.4 characterized two forms of kinship care. Informal kinship care is arranged privately between parent and caregiver; formal kinship care (also known as relative foster care) occurs when children are in custody of a public child welfare agency as a result of abuse or neglect. A child who has experienced maltreatment may enter either formal or informal kinship care, depending on whether maltreatment was first identified by the system or by a concerned relative willing to take responsibility for the child. The implications for the child are substantial in terms of access to services and case management. While the TANF system is designed primarily for economic support, child welfare agencies are able to offer higher levels of financial support, greater access to services, and ongoing case management. However, many relatives avoid contact with child welfare agencies for fear that children might be placed in nonrelative foster care. The following paragraphs outline these distinctions; more detailed descriptions of practice in the study states are provided in Section 4.4.
A major difference between formal and informal care is in the financial support available to relative caregivers. Table 4-3 shows the difference in monthly financial support between child-only TANF and foster care, assuming relatives are licensed foster care providers. Child-only TANF grants for a single child range from $89 (Oklahoma) to $349 (Washington), while foster care payments range from $360 (Oklahoma) to $535 (Maryland). Because child-only TANF grants increase by progressively smaller increments as the number of children increases, the differences for multiple children are even more substantial.
Disparities between child-only TANF grants and foster care stipends are substantial in each of the five states, but vary in degree. In Louisiana and Oklahoma, the child-only TANF grant for a relative caring for three children is equivalent to 22 percent of the foster care stipend for three children. Washington's TANF grant for a single child is much closer to that of foster care (82 percent), but the ratio drops to 43 percent for three children. In Wisconsin, the only state of the five that provides full support for additional children, the child-only TANF grant is equivalent to 66 percent of the foster care stipend regardless of family size.
| Louisiana | Maryland | Oklahoma | Washington | Wisconsin | ||
|---|---|---|---|---|---|---|
| Informal Kinship Care: Program Name | Family Independence Transitional Assistance Program (FITAP) | Kinship Care Subsidy Program (KCSP) | Temporary Cash Assistance (TCA) | Child-Only TANF | Child-Only TANF | Voluntary Kinship |
| Payment: | ||||||
| 1 child | $122 | $300 | $213 | $89 | $349 | $215 |
| 3 children | $240 | $900 | $477 | $241 | $546 | $645 |
| Foster Care(a) Payment: | ||||||
| 1 child | $365 | $535 | $360 | $427 | $326 | |
| 3 children | $1,095 | $1,605 | $1,080 | $1,281 | $978 | |
| (a): Basic foster care stipend for 9-year-old child (Child Welfare League of America, 2001). | ||||||
Service availability also varies according to whether a child is in formal or informal care. When children are in child welfare custody, the agency, as legal parent, is required to ensure that they receive needed services, such as diagnostic evaluations and mental health services. While difficulties in accessing needed services certainly occur, services are part of a court-ordered treatment plan and the presumption is that they should be provided. By contrast, services to children in informal kinship care may include financial supports such as Medicaid for children, child care for working caregivers, and annual supplemental or emergency funds. Even this limited set of supports was not available to all children in the study states. Relative caregivers who are elderly may have access to additional services such as support groups, kinship navigators, and resource guides.
| "I was told that they would need to give the children to child welfare,
and then child welfare would decide if they would give the children back."
Relative caregiver, Oklahoma |
Another area of distinction is seen in case management provided to children, including initial assessments and ongoing supervision. Children in formal kinship care receive a comprehensive assessment early in the custody period, and are visited every 1 to 3 months by a social worker whose training is child-focused. For children in informal kinship care, intake and ongoing services are typically focused on eligibility requirements, and conducted by a financial service worker who is not required to have had any training in child development. Children are not required to be present during these interactions. Assessments for child-only cases, when conducted at all, were described as "conversational" inquiries as to whether services or assistance were needed. Caregivers who request help may be referred to a social worker.
Many relative caregivers participating in focus groups described serious maltreatment situations from which they had removed children. They reasoned that the care they provided was keeping these children out of the foster care system, and questioned why they received so much less financial support and fewer services than foster parents. A few described contacting child welfare agencies and being told that because the children were safely in the care of relatives and not currently being abused or neglected, the child welfare agency had no authority to provide services to them. Some child welfare agencies offer services to children in informal relative care on a preventive basis, such as family preservation services available in Maryland. However, few relative caregivers said that they would voluntarily approach the child welfare system, even for desperately needed services. They worried that if "the system" became involved they might lose custody of the children due to their age or the condition of their homes.
For those children who are in child welfare custody, states vary in their requirements and supports for relatives providing care. As described in Section 2.4, most states offer some flexibility in licensing or approval processes to relative caregivers who do not meet all of the training and home inspection criteria required of nonrelative foster parents. Depending on the type of license and whether the child is eligible for Federal foster care support under terms of Title IV-E of the Social Security Act, relatives may receive the full foster care stipend, a modified amount, or the equivalent of child-only TANF.
States visited for this study varied dramatically in the extent to which relatives participated as licensed foster parents, as shown in Table 4-4. For example, Oklahoma encourages relatives to pursue licensure. While many relative caregivers receive child-only TANF as interim support while completing licensing requirements, relatively few choose to remain as unlicensed foster parents. Maryland reports that relative caregivers are evenly divided between licensed and unlicensed (approved) status. Other states, such as Washington, report that few relatives are willing to pursue licensure, although they are encouraged to do so. Among children in foster care with relative caregivers in Washington, an estimated 10 percent are in the care of relative caregivers who are also licensed foster parents (Mayfield, Pennucci, and Lyon, 2002). Because state child welfare systems do not necessarily track data on whether relative caregivers are licensed, and TANF agencies are not required to track the child welfare status of children in TANF child-only cases with relative caregivers, estimates of the prevalence of these arrangements are not readily available, even to those within the child welfare or TANF agency.
| Louisiana | Maryland | Oklahoma | Washington | Wisconsin | |
|---|---|---|---|---|---|
| Estimated children in unlicensed relative care | Not available(a) | 2,000 | 500 | 3,500 | 1,700 |
| Estimated children in licensed relative care | Not available | 2,000 | Not available | 400 | Not available |
| Requirements for licensed relative care | Same as for nonkin | Modified | Same as for nonkin | Same as for nonkin | Same as for nonkin |
| Supervision for licensed relative care(b) | Same as for nonkin | Same as for nonkin | Same as for nonkin | Same as for nonkin | Less than for nonkin |
| (a): Louisiana estimates 1,075
children in relative foster care but cannot estimate the proportions in licensed
and unlicensed care. (b): Source: Boots and Geen, 1998. |
|||||
Collaboration between TANF and child welfare agencies varied across the five states visited, and to some extent, within states as well. At the state level, Washington has convened a workgroup to address shared issues, and the Washington State Institute for Public Policy has convened a multidisciplinary task force to study issues and strategies. In other states, development or lack of collaborative strategies appears to occur at the local level, if at all.
While child welfare and TANF agencies were located within the same parent agency in all states visited, the extent of collaboration varies substantially across and within states. In Louisiana, where agencies are located in the same department but appear to have little contact with each other at the parish level, we heard no reports of either formal or informal collaboration. In Wisconsin, by contrast, children in TANF child-only cases with relative caregivers were managed from within the child welfare agency in the counties visited, although officials noted that this is not the case in every county.
In Oklahoma, TANF and child welfare are housed in two divisions within the Department of Human Services, with a common director at the local level. For child-only cases in formal kinship care, child welfare workers are responsible for child safety and service needs, while TANF workers are responsible for financial and medical assistance. In the smallest site visited in Oklahoma (Pottawatamie County), both divisions are located within a single building, and workers report a high level of informal collaboration. Workers frequently communicate about cases that are seen by both agencies, either concurrently or at different times. In the larger, urban office visited in Oklahoma, informants reported far less informal collaboration. Maryland also reported that collaboration varied according to both the size of the county and the specific county involved.
| "They call us when they need something. Otherwise, we don't get into
their business." TANF Worker |
Informants described a variety of collaborations for informally sharing information. They most commonly described information-sharing strategies. In Maryland, some counties reported conducting joint case staffings, in what Kevin McGuire, Executive Director of the Family Investment Administration describes as an innovative approach that "makes effective use of the time and talent that they have." Oklahoma City staff also described joint staffings, with activities required for a child welfare treatment plan accepted as counting toward the TANF work requirements.
Computer systems in Oklahoma and Washington allow some information sharing across child welfare and TANF agencies, although the systems are not fully integrated. Pottawatomie County, Oklahoma, holds monthly staff meetings for both TANF and child welfare staff to provide training on common issues. Washington's Region 5 TANF staff participate in community-wide networking brown-bag lunch meetings for service providers, and in a city-wide resource network.
Child welfare informants in Oklahoma and Washington described making referrals to TANF, most commonly for relative caregivers who were not licensed foster parents and were seeking financial support. In Oklahoma, child welfare workers help relatives with the application for child-only TANF, then transfer the application to the TANF office for processing. In Washington, service agencies provide information and assistance to applicants for programs other than their own through the Coordinated Service Initiative, also known as "No Wrong Door."
Maryland offered some examples of resource sharing to address shared population issues. In Baltimore, social workers paid with TANF funds are stationed in district offices to respond to social and welfare issues. Some Oklahoma City TANF offices have child welfare workers assigned to assist relative caregivers with services.
With the exception of Wisconsin, it is somewhat striking that informants did not describe more collaborative efforts related to case management and service provision. In several discussions, workers from either child welfare or TANF observed that they did not know enough about each others' programs. Several informants acknowledged that child welfare and TANF caseloads had similar needs, and overlapped at times. However, the two agencies operate under very different mandates, and consequently with distinct resources, philosophies, and expectations.
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In four of the five states, policies for TANF relative caregiver cases are developed by the same people that develop polices for the state's TANF program. In these four states, the relative caregiver cases are processed almost exactly the same as a TANF case headed by one or both parents of the children. The intake processes for relative caregiver cases in these four states are very similar. Income maintenance workers determine eligibility. In the fifth state, Wisconsin, child welfare staff develop the policies and procedures for relative caregiver cases. As a result, the procedures for handling a kinship care TANF case are similar to those for child welfare cases. Staffing assignments in Wisconsin are delegated to individual counties. In some counties, these relative caregiver cases are handled by a protective services social worker. In others, the cases are handled by Wisconsin Works (W2) income maintenance staff.
While procedures in Louisiana are similar to those in the three other states where relative caregiver policies are developed by the state's TANF policy unit, there are some slight differences. These differences are due to the fact that there are two separate TANF grant programs: one specifically for relatives who are taking care of children, and the other for families. Both programs are handled by parish income maintenance staff. The Kinship Care Subsidy Program (KCSP) is designed for kinship care cases. The KCSP payments are substantially higher than those for the Family Independence Temporary Assistance Program (FITAP), as shown in Table 4-4. This is particularly true when the relative cares for more than one child. To be eligible for KCSP, the relative caregiver must have some form of custody for the child. The relative can receive a KCSP for one year while he or she seeks to obtain custody. If the relative has not obtained custody within 12 months, the KCSP case is closed. In addition to custody, the relative caregiver's household income must be below 150 percent of the poverty level.
FITAP, the state's standard TANF program, provides assistances to families and includes an employment and training component. The lines between these two programs are flexible, and there are instances when a relative caregiver may choose to apply for FITAP instead of KCSP. In addition to caregivers who do not wish to pursue custody, or whose income is over the eligibility limit for KCSP, caregivers may choose FITAP for its employment and training benefits. Under FITAP, relative caregivers can also choose to be included in the grant. If caregivers are able bodied and not elderly, they are required to participate in the state's Strategies to Empower Program (STEP) for employment, but will be eligible for Medicaid coverage for themselves.
The eligibility processes in the three other states where the polices for relative caregiver cases are developed by the state's TANF unit — Maryland, Oklahoma, and Washington — are very similar. In these states, the relative caregivers are interviewed by income maintenance staff. Frequently, these cases are given priority processing. In Washington, these cases are seen the day they come to the office as opposed to regular TANF cases that are scheduled for a follow-up interview. In some counties in Maryland, relatives can make appointments for interviews ahead of time. In other counties, they are seen on a first come, first served basis.
The State of Wisconsin manages relative child-only cases through child protective services. This program is similar to a jointly funded kinship care program in that only relative caregiver child-only cases are managed though the child protective services system. The only financial requirement for relative caregivers to receive a kinship care payment in Wisconsin is that the child does not receive SSI. Additionally, to receive kinship care, a determination needs to be made that a child is in need of protective services (CHIPS) or that the child is at risk of needing protective services. Kinship care intake workers make this determination when relatives apply for child-only TANF assistance. As part of the eligibility process, the kinship case worker conducts a background check on the relative caregiver, conducts a home study, and confirms that parental permission for the arrangement has been documented. For children in the child welfare system, the need for protective services is established by court order. For children outside the child welfare system, the determination of "at risk for protective services" is established as part of the kinship care intake worker's assessment. Parental child-only cases are maintained and managed within the TANF system.
In Wisconsin, unlike other states, funding for the kinship care program is based on a biennial allocation of funds, which are allocated across counties. Counties are responsible for month-to-month budgeting. At the state level, county kinship care expenditures are monitored on an ongoing basis, and may be re-allocated to balance shortfalls and surpluses among counties. Since there is no guarantee to counties that additional funds will be available, some counties establish wait lists of kinship care cases, while others use county funds to cover any shortfall in state kinship care funding. Counties are required to fund all court-ordered kinship care referrals.
Eligibility criteria for relative caretakers vary among the states. In Wisconsin, a person can be related through marriage, blood, or adoption. Louisiana uses a fifth degree of consanguinity rule, which includes great, great grandparents, aunts, uncles, and up to once-removed cousins. This relationship can include biological or adoptive relatives. Maryland also allows biological or adoptive relatives to apply. A grandmother in Maryland reported that she takes care of her two grandchildren plus a step-grandchild who is the son of her son's girlfriend and another man. She receives a Temporary Cash Assistance (TCA) child-only grant for her two grandchildren but nothing for the step-grandchild. She said she chose to take care of the step-grandchild without a TCA grant because she wanted to keep the family together and did not want the step-grandchild to enter the foster care system. If the woman had been living in Louisiana (and had appropriate custody for the two grandchildren), she could have applied for KCSP payments for the two grandchildren and a FITAP grant for the step-grandchild.
In all states, relatives are informed that they must cooperate with the child support enforcement agency for their application to be approved. All five states allow for exemptions from cooperation with child support for "good cause" reasons, such as the possibility of domestic violence or a threat to the child if child support is pursued. Workers in all states acknowledged that cooperation with child support could be a barrier but that most relatives were willing to comply. As one worker in Louisiana said, "most grandparents are upset that they have to take the kids...[they say] 'Good luck in trying to find them and getting anything from them.'"
However, several workers provided anecdotal support that child support could be a barrier to pursuing kinship care. One worker said she had heard that some parents threatened to take back the child if child support payments were pursued. Another said, "Grandparents have withdrawn applications because of child support enforcement. Parents can say 'Don't go after support' and grandparents don't do it because they don't want kids causing problems."
A worker in Wisconsin reported that child support can be an issue during both initial applications and recertifications. "I would estimate that about 20 percent of my home studies drop out of the application process because of this [the child support] requirement. I have not had any parents pull children out of relative placement [after the case is initially approved] because of this requirement, but they will on the annual review say 'No, I don't think my child needs to be in relative placement anymore' and then they will refuse to sign the voluntary placement agreement." She estimated that this occurs in about 5 percent of her recertifications.
Relative caregivers may have other reasons for finding it difficult to cooperate with child support enforcement. Some grandparents may not know who the father of their grandchild is, or may be reluctant to discuss their children's complicated relationship histories.
Assessment, as used in this report, refers to a specific effort to identify the well-being and service needs of the child and family. Assessment might include using a tool to identify specific service needs, or could be a more general process of monitoring family dynamics and analyzing (or assessing) the need for support services. Assessment of child and family needs differs from intake and eligibility screening in that it is more definitive with a focus on identifying the well-being of the child and caregiver.
TANF System
Generally, a person's first interaction with the TANF program occurs at the point of application and eligibility determination. According to the American Public Human Services Association (APHSA), states report collecting a great deal of assessment data (APHSA, 2000). All 50 states and the District of Columbia reported to the APHSA conducting client assessments in the following areas:
However, these assessments focus on households that include a parent, with a primary interest on the adult and on identifying barriers to employment. With the work requirement removed from child-only relative caregiver cases, much of the "standard" assessment used by counties and states is no longer applicable.
None of the five states reported conducting any formal assessment of child-only relative caregiver cases at intake. Louisiana reported completing a Family Needs Assessment at the time of application for regular TANF cases, but stated that due to staff constraints and size of caseloads, it is not realistic to complete this assessment on child-only cases. The issue of staff time and caseload size is not uncommon. The report Screening and Assessment in TANF/Welfare-to-Work: Ten Important Questions TANF Agencies and Their Partners Should Consider (DHHS, 2001) concluded that a TANF staff's ability to screen and assess may be affected by the size of their individual caseloads. Although nationwide TANF caseloads have declined, these declines often mask high individual worker to caseload ratios.
| "We are eligibility workers — not social workers. Our focus is on
economic eligibility." Eligibility Worker, Maryland |
This same report also notes that staff hired to perform eligibility functions are required to pay close attention to detail and understand the complex budgeting requirements needed to determine if a family is eligible for TANF. This skill set differs markedly from the skills required to conduct assessments of family dynamics and develop relationships with clients that foster trust and facilitate disclosure of family issues and service needs. Eligibility workers in several states confirmed this distinction. Financial workers in Washington State noted that "the eligibility assessment is primarily a black-and-white financial assessment." They stated that "this may seem cold; however, our primary focus is on financial need and eligibility." As a TANF eligibility worker in Maryland stated, "TANF staff are not trained social workers — they can only refer for services from an outdated resource list. A TANF financial worker in Washington stated that "the [TANF] maintenance worker has a minimal role in assessing the needs of the child."
Four of the five states visited conduct minimal assessments at the time of eligibility and during reassessment. Typically, case managers ensure that immunizations are up-to-date and confirm school attendance. The focus remains on the adult (e.g., caregiver) and the child is often not even present during the assessment. When the child is present, they may be hesitant to speak freely in front of their relative, particularly about issues related to parental unfitness or child maltreatment. As a social worker in Washington stated, "The problem with the assessment of these children is that the caregiver is with the child 90 percent of the time and there are topics that the child is not willing to discuss in front of their relative."
The State of Wisconsin is the exception to this pattern. Because child-only relative caregiver cases in some counties are managed from within the child welfare agency, initial and ongoing assessments of the child and family are conducted by a social worker. While this assessment is more in-depth than any assessment reported by other states, it is still not a formal well-being assessment of the child or the family.
Child Welfare System
Assessment is more intense when a child-only relative caregiver case is involved with the child welfare system. After CPS removes a child from their home, child welfare caseworkers conduct an in-depth assessment of the child's individual needs and family circumstances. CPS then uses this assessment to develop a permanency plan for the child. Additionally, many child welfare agencies have adopted the 2002 American Academy of Pediatric Guidelines, recommending initial and ongoing assessments to ensure that children's health and developmental needs are met.
| "No one really knows what's going on with these kids unless there is
a CPS worker involved." Child Welfare Worker, Maryland |
As a result, children linked to the child welfare system are receiving a much more thorough assessment of their service needs. A TANF worker in Oklahoma stated, "If CPS is involved, much more information is obtained. An evaluation of their well-being needs — educational, medical, emotional, and dental - is conducted and criminal background checks are run on the relative caregiver." A TANF eligibility worker in Washington agrees that "having the child placed through CPS does open up the door to many resources that the families where children were not placed through CPS do not have." A child welfare social worker in Washington points out that "our assessment is much different than one that would be done through TANF. We are the social service experts; therefore, needs are better addressed through our office." The kinship care coordinator in Wisconsin, who is housed within the child welfare system, also supports this notion. She stated that the "assessment process through CPS is continuous — first assessing that basic needs are met for food, shelter, and clothing and then making sure that emotional needs are met."
This level of involvement continues from the initial assessment through ongoing assessments with the child and relative caregiver. Typically, ongoing visits and assessments occur once a month on open cases. Social workers conduct home visits to make sure children are getting their immunizations and checkups, confirm that they are in school, and assess for support services. As a CPS social worker in Washington stated, "If CPS is involved, they are managing the social service needs of the family."
Although children in child welfare custody are more likely to be assessed, and those assessments are more likely to be conducted by trained social workers, this process may also fall short of recommended standards. The kinship care coordinator in Wisconsin noted that even in the child welfare system, "Basic needs and social service needs are assessed during ongoing assessments, but there is no formal assessment of well-being at this time."
Children who live with relative caregivers and receive a child-only grant may receive several other income maintenance supports available to all families receiving TANF. These services include medical coverage (discussed in the following section), food stamps, child care, and funds to address special needs. Many relative caregivers are eligible for assistance through the Low Income Home Energy Assistance Program (LIHEAP). In addition, a number of states maintain supplemental funds that can be accessed for relative caregiver cases. The differences and similarities across states in applying for and receiving these benefits are described below.
States vary widely in the percentage of relative caregiver households that received food stamps. Workers in Louisiana estimated that close to 80 to 90 percent of the relatives receiving KCSP payments received food stamps, while workers in Wisconsin estimated that 15 percent or less of the households receiving kinship care payments received them. Workers in Oklahoma, Washington, and Maryland reported that relative caregivers' incomes were usually too high for the household to receive food stamps. A worker in Maryland reported, "People who are just receiving [TCA payments] for children and not in the [assistance] unit are probably ineligible for food stamps. Families are very upset when they find out food stamps are not available. They do not understand why the federal government does not pay for food if they give them cash and medical [assistance]."
Household income may also be a barrier to a relative caregiver receiving subsidized child care. In many of the states visited, child care subsidies are targeted for families that receive TANF and are participating in employment and training activities or for families that leave TANF after obtaining a job. There may be insufficient child care funding to assist relative caregivers. A worker in Maryland said that if the relative caregiver is working, the family's income will likely be too high to qualify for child care; even if the caregiver qualified, they would be added to a long waiting list for support. In Wisconsin, on the other hand, a worker estimated that 35 to 40 percent of the kinship care caseload in her county received a day care subsidy. Subsidized day care in Washington or Oklahoma is authorized if the relative caregiver is working. Oklahoma also provides respite care.
Several states also offer supplemental financial supports for children in TANF child-only cases with relative caregivers. In Oklahoma, supplemental service funds are available for school clothes and supplies, counseling, and other services not covered by Medicaid; legal fees related to guardianship; shelter emergencies; and some transportation expenses. The annual limit for these funds was cut in half for the most recent fiscal year, to $750. In Washington, relative caregiver families may be eligible for up to $750 per year for emergency expenses, or $1,500 diversion assistance to prevent nonneedy caregivers from being added to the assistance unit. Several counties in Wisconsin also have funds to cover emergencies and special needs of children in kinship care.
Medical coverage is typically the most critical service for relative caregivers. A Louisiana worker noted that it was often more of a concern than the child-only TANF grant. The worker added that the relative will say, "I don't really need this but I need the Medicaid for the child." Staff in a Washington local office reported that they typically could arrange immediate Medicaid coverage for relative caregiver cases.
In Maryland, Oklahoma, and Washington, all children who receive child-only TANF payments are automatically covered by Medicaid. To receive medical coverage in Louisiana under KCSP or through kinship care in Wisconsin, the relative caregiver must contact a separate human service office, which is in charge of applications for Medicaid and the State Children's Health Insurance Program (SCHIP).
In Wisconsin, children in relative care receive Medicaid managed care, while children in foster care receive fee-for-service Medicaid. This situation creates challenges for children who transition from foster care to relative care. Because not all providers accept Medicaid managed care, children may need to change providers, especially for mental health care.
Well-child visits, vision and hearing screening, dental services and mental health services are covered by Medicaid under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Few children are insured privately by their caregivers. Relative caregivers voiced complaints commonly heard among Medicaid populations regarding the dearth of providers in certain specialties, including psychiatrists, dentists, and orthodontists. As a Wisconsin grandmother noted, "This [Medicaid] service is very lacking. There are not doctors or dentists available that can provide services. Even if you have medical assistance, you can't get services for the kids."
Across the five states, informants noted that children in relative care often had distinct mental health needs. Unlike children in TANF households, children in TANF cases with relative caregivers are typically separated from their parents because their parents were incarcerated, abused alcohol and/or drugs, or their whereabouts were unknown. These children often have long-term issues stemming from sexual abuse, exploitation, and separation and attachment disorders, requiring counseling and therapy.
Informants noted that many relative caregivers lack the skills necessary to identify children's needs and locate appropriate services. Caregivers who lack knowledge of available services and who have no experience with maneuvering the Medicaid and welfare systems to receive needed services have particular difficulties.
| "Relatives have no recourse, unless they're pretty savvy to the system."
Child Welfare Worker, Washington |
Although many informants reported that mental health and counseling services were needed, several factors limited access to treatment. These factors include a lack of providers who accept Medicaid, a lack of providers who provide quality care, long waiting times for appointments, and insufficient treatment for children's needs. These issues are further exacerbated for children living in rural areas where there is a lack of providers generally, children living with caregivers who lack transportation, and children in managed care.
There is little ongoing supervision of relative caregiver cases. All states review these cases annually for recertification, and Louisiana, Oklahoma, and Washington conduct semiannual reviews, as well. Other than during these times, relative caregiver cases do not interact with workers unless they initiate contact. This is a sharp contrast to adult TANF cases and child welfare cases, where case managers typically have monthly contact with their clients.
| "Child-only cases are managed at the time of application, at recertification
and at closure. There is nothing else done with them." Intake Worker |
Case management provided for relative caregiver cases differs from that provided to regular TANF cases. While the focus of case management in regular TANF cases is on parents' employment, training, and progress toward self-sufficiency, in child-only cases, relative caregivers are exempt from work requirements. Many caregivers are grandparents whose concerns may focus on issues such as disabilities, fixed incomes, and lack of familiarity with the welfare system. The purpose of case management is not to move caregivers off of welfare, but rather to maintain the status quo and, in some cases, to address service needs.
Organization of case management for relative caregiver cases varies across states and sometimes within states. As described earlier, the sites visited in Wisconsin use kinship care workers located within the child welfare agency. Among other states, some sites have placed non-needy relatives into a single caseload. This grouping allows a small number of workers to become more familiar with the caregivers' needs and relevant community resources.
At other sites, relative caregivers are mixed into the general TANF caseload. This model is popular with TANF workers who typically find relative caregiver cases to be their easiest ones to manage. There are few requirements in terms of monitoring, and no requirements of beneficiaries in terms of employment and training, unlike regular TANF cases. One informant suggested that caseworkers liked to have relative caregiver cases if only to realize some sort of success with a case, as opposed to adult TANF cases where employment and education issues were challenging. Relative caregiver cases also tend to be stable, with few changes in household arrangements. Most are seen as long-term cases, closing only when children reach 18 years old.
The recertification process for relative caregiver cases also varies by state. In some states, recertification is conducted through face-to-face interviews, either in the office or through a home visit. In other states, recertification is conducted by telephone or via mail. At recertification, case managers review eligibility, confirm that the children are still in the home, and ask about any assistance needed (e.g., housing, mental health services, counseling). Some states also require documentation that children are attending school and are up to date with immunizations and doctor visits.
When asked how well the case management system worked in their state, many informants indicated that it works well because there are so few regulations and reporting requirements for these cases. They also acknowledged that case management works well because case managers are doing what they are supposed to do — reviewing the file only on an annual or semiannual basis. Many recognized the shortcomings of the case management system for these cases and wished that they could do more for them. However, due to the lack of manpower, resources, and time, case managers typically do only what is required, and focus on cases that require more of their attention. Some were concerned that overburdened staff may miss the subtle needs of caregivers. Informants believed it is unfortunate, but noted that case managers have little knowledge about what is occurring in the cases if caregivers do not contact them.
Custody arrangements for children in informal kinship care vary. Children in formal kinship care are, by definition, in the custody of a public child welfare agency. For informal kinship care, none of the states visited require relative caregivers to have legal custody of children for whom they are caring. Relatives can establish voluntary custody fairly readily if the child's parent is available to provide written consent to the caregiving arrangement. This process establishes their authority to make routine decisions on the child's behalf. Wisconsin requires documentation of parental consent for TANF child-only cases with relative caregivers, and Louisiana's Kinship Care Support Program requires that relative caregivers establish custody within one year.
| "In essence, I have no rights. If my daughter shows up, high on whatever,
she can just walk off with my granddaughter." Relative Caregiver, Washington |
Many relative caregivers participating in focus groups would like to go further than this and establish permanent legal custody to ensure that children are not returned to a parent who does not adequately care for them. This is a far more demanding process, requiring the caregiver to document parental unfitness in court. The high cost of legal assistance for this process (reported to be between $800 and $3,000 per child by relative caregivers in Oklahoma) make this infeasible for most caregivers. A few participants in different states reported having completed this procedure, either at great cost to themselves, or (in one case) by finding a lawyer willing to work pro bono to protect the relative children from their parents.
Children in formal kinship care receive periodic permanency reviews to assess whether their living arrangement offers them long-term safety, stability, and preservation of family and community bonds (DHHS, 2000). Especially for younger children, adoption is seen as the preferred arrangement when reunification with birth parents is not possible. Relatives who adopt children who have been in foster care are often eligible for adoption subsidy payments until the child is at least 18 years old, as well as reimbursement for legal costs associated with the adoption. These benefits are not available to informal kinship care providers.
Although most relative caregivers intend to raise children until adulthood (Edelhoch, Liu, and Martin, 2002), many caregivers are reluctant to adopt these children for a variety of cultural and interpersonal reasons. Because of the preference given to placement with relative caregivers, states are not required to pursue termination of parental rights and adoption for children in kinship care (DHHS, 2000). As an intermediate strategy to offer children greater permanency without disrupting other family relationships, four of the five states visited offer subsidized guardianship arrangements for relatives willing to assume legal long-term responsibility for children. These arrangements remove relative caregivers from the supervision of child welfare agencies, generally with a higher level of financial support than is available from child-only TANF. In Louisiana and Maryland, the support level is more than child-only TANF but less than foster care; in Oklahoma and Wisconsin the support level is equivalent to foster care. All programs provide the full amount of support for multiple children rather than incremental increases provided by child-only TANF. Table 4-5 summarizes these programs. Wisconsin officials noted that there is a pilot guardianship program, similar to Maryland's, in Milwaukee. In all states except Louisiana, these arrangements are available only to children who have been in state custody. Maryland's program is funded through a IV-E waiver, while others are supported by state funds.
| Relative Guardianship Program | Louisiana | Maryland | Oklahoma | Wisconsin |
|---|---|---|---|---|
| Program Name | Kinship Care Subsidy Program (KCSP) | IV-E Waiver Guardianship | Supported Permanency | Long-Term Kinship Care (Chapter 48.977) |
| Population | Low-income relative caregivers | Children formerly in kinship foster care | Children over age 12 in formal kinship care, for whom reunification is not likely | Children who have been in court-ordered kinship care |
| Payment per Child: | (same as foster care) | (child-only TANF) | ||
| 1 child | $222 | $300 | $360 | $215 |
| 3 children | $666 | $900 | $1,080 | $645 |
| Estimated Children: | 4,000 | 300-500 | 252 | Requested |
| Custody | Must establish provisional or actual custody within 1 year of entry | Relative guardianship | Relative guardianship: TANF block grant pays legal fees | Relative guardianship |
Several of the states have special initiatives under way to address the needs of relative caregivers. In many instances, these efforts were undertaken by the state human service agency that deals with aging. Two states — Louisiana and Washington — also are pursuing a "no wrong door" approach to meeting client needs.
Wisconsin used a $3,000 grant from the Brookdale Foundation to develop its Grandparents Raising Grandchildren program. While several efforts were launched across the state, one of the strongest is located at the Oshkosh Senior Center. As part of that effort, monthly programs are offered for grandparents and the children they are raising. A meal is provided at the meetings, then the children go to a play room while an information session is provided for the grandparents. As part of a related effort, the state Bureau of Aging and Long Term Care developed a resource directory called GRAND. It was designed to be replicated easily in each county across the state. GRAND provides information on housing, legal services, mental health, and financial assistance. The state's cooperative extension service collaborates in these efforts.
The DSHS unit on aging in Washington is involved with 42 support groups across the state. These support groups provide a number of referral services. Tribal organizations across the state also provide support services for members. The unit also has produced three information guides: Relatives as Parent; Legal Guide (3rd Edition); and Relative's Guide to Child Services. The unit has coordinated some activities with the American Association of Retired Persons (AARP), which provides a handout on relative caregivers to schools. The unit also has worked with pharmacies to print information for aging relative caregivers on pharmacy bags. In addition, the unit also developed a handout entitled "Sticking Together: Kinship Care and Financial Care," which describes available services.
Maryland's aging service office funds a kinship care resource center. As part of that effort, the office has developed a resource guide for the entire state that provides linkages to county level services. The office funded five support groups for relatives providing kinship care to help them navigate the system. All groups met at least monthly, with some groups meeting on a weekly basis. The meetings dealt with such topics as financial issues for children, mental health issues, behavior and school problems, medical issues, and special needs. The support groups are now funded through a different agency.
Organizations for grandparents are also active in two other states involved in this study. The Aging Service Division in Oklahoma has sponsored a grandparents' conference for the last 7 years. The state is currently conducting a survey of 500 grandparents to assess their needs. The grandparents' association in Louisiana successfully lobbied a state representative several years ago to introduce legislation to create KCSP.
[ Go to Contents ]
Across the five sites visited, three themes were voiced consistently, and from a variety of perspectives:
The states visited as part of this study have implemented a variety of strategies to address the needs of children in TANF child-only cases and their relative caregivers. These strategies include tailoring intake and recertification procedures to meet the needs of relative caregivers, providing social support and resource networks for elderly caregivers, and offering supplemental funds to augment child-only TANF grants. One state offers enhanced financial support for low-income relative caregivers, as do several other states not participating in the case studies.
A major distinction among the five states is their response to formal kinship care providers who care for children in child welfare custody. Among the two states for whom estimates were available, the proportion of kinship caregivers who were licensed as foster parents ranged from 10 to 50 percent. Caregivers who do not meet licensure requirements receive substantially less financial support. These distinctions are offset in some states by the availability of supported guardianship programs for relatives who assume long-term custody of children formerly in state custody.
Informants in each of the case study sites recognized the similarities between formal and informal kinship care populations, and the fact that many children travel between child welfare involvement and informal kinship care over time. To varying degrees within and across the five states, collaborative efforts attempt to improve communication, share resources, and otherwise bridge the gap between child welfare and TANF agencies. Only in some Wisconsin counties have structural changes been implemented to bring children in TANF child-only cases with relative caregivers closer to the type of child-focused services and supervision provided for children in child welfare custody.
Many TANF agency representatives pointed out that children in TANF child-only cases with relative caregivers were likely to be better off in their current situation than they had been with their parents. However, to the extent that these children would have received services from a child welfare agency had their circumstances been known, or had a relative not intervened, they are substantially underserved. Children in TANF child-only cases with relative caregivers do not have access to the comprehensive assessments, support services, financial support, and permanency planning provided to those in state custody.
Because informal kinship care providers receive far less caregiver assessment and ongoing supervision, the risk remains that children are placed in the care of yet another inadequate or even dangerous caregiver. The child welfare system, working under critical resource constraints, has no mandate to serve these children; the TANF agency has neither the resources nor the expertise to meet their needs.
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