1. HEALTHY GRANDPARENTS PROGRAM: SUPPORTING INTERGENERATIONAL FAMILIES
Mary Lou Davis, PhD, Program Director
Mike Patton, MSW, Program Coordinator
PURPOSE/BACKGROUND
The Healthy Grandparents Program was established in January of 1999 to provide physical, emotional, and social support to grandparents and great-grandparents raising their grandchildren ages 0-17 living in parent-absent homes. The program serves families in both Richmond and Columbia Counties and services are designed to increase families’ access to resources, increase family empowerment and independence, and promote stability and permanency in children’s lives while maintaining their family ties and culture. The primary goal is to support intergenerational families so children can experience a stable and supportive home environment without having to enter and/or re-enter the formal foster care system. Grandparent caregivers have demonstrated a significant need for social/peer support, mental and physical health care, child development education, child custody/adoption assistance, access to information and resources, respite care, and advocacy. To date, the program has provided services to over 400 families, 540 grandparents and over 850 children, while assisting grandparents to secure full legal custody and/or adopt over 230 of their grandchildren with the help of local private attorneys.
Mary Lou Davis, PhD, Program Director and Mike Patton, MSW, Program Coordinator

2. 2.7 million grandparents responsible for their grandchildren’s care
NATIONAL DATA
2.7 million grandparents responsible for their grandchildren’s care
40% have provided care for more than 5 years
58% are still in the workforce
21% grandparents live below the poverty level
1 million children living with grandparents & neither parent present
NATIONAL/STATEWIDE STATISTICS
According to data from the 2013 American Community Survey, there are 2.7 million grandparents across the U.S. responsible for their grandchildren’s care. Almost 60% of those grandparents are still in the workforce and 40% of them have provided care for their grandchildren for more than 5 years. Nearly 1 million children are living in homes where the grandparent is the householder and neither parent is present in the home.
The number of grandparents raising grandchildren is up 7 percent from 2009; There was no change in the percentage of grandparents responsible for grandchildren where the grandchild’s parents were not living in the household, which remained stable at about 34.0 percent.
In Georgia alone, there are over 115,000 children living in homes where their grandparents are responsible for them and neither parent present in the home. In 2012, Georgia had the 6th largest number of grandparents living with their grandchildren in the country. In Richmond and Columbia Counties alone, there are over 4,700 grandparents responsible for their grandchildren’s care. Almost 2,000 of those grandparents are raising their grandchildren without either parent present in the home and 27% have been raising their grandchildren for more than 5 years.
Ellis & Simmons (2014); U. S. Census Bureau. (2015; 2016)

3. Ellis & Simmons (2014)

4. NATIONAL DATA Ellis & Simmons (2014); National Kids Count (2015)
NATIONAL/STATEWIDE STATISTICS
According to data from the 2013 American Community Survey, there are 2.7 million grandparents across the U.S. responsible for their grandchildren’s care. Almost 60% of those grandparents are still in the workforce and 40% of them have provided care for their grandchildren for more than 5 years. Nearly 1 million children are living in homes where the grandparent is the householder and neither parent is present in the home.
The number of grandparents raising grandchildren is up 7 percent from 2009; There was no change in the percentage of grandparents responsible for grandchildren where the grandchild’s parents were not living in the household, which remained stable at about 34.0 percent.
In Georgia alone, there are over 115,000 children living in homes where their grandparents are responsible for them and neither parent present in the home. In 2012, Georgia had the 6th largest number of grandparents living with their grandchildren in the country. In Richmond and Columbia Counties alone, there are over 4,700 grandparents responsible for their grandchildren’s care. Almost 2,000 of those grandparents are raising their grandchildren without either parent present in the home and 27% have been raising their grandchildren for more than 5 years.
2005 through 2015 American Community Survey
Ellis & Simmons (2014); National Kids Count (2015)

5. AARP (2015); Ellis & Simmons (2014)
STATEWIDE DATA
Estimates of 85,000 to 102,000 grandparents are responsible for their grandchildren’s care & neither parent present
6th highest in the nation
78% increase over the past decade, compared to 18% nationally
41% have no parents of the children present in the home
27% have provided care for more than 5 years
22% of children in foster care are in state-supervised relative foster care
Over 100,000 grandparents are responsible for their grandchildren’s care & neither parent present
In Georgia alone, there are over 115,000 children living in homes where their grandparents are responsible for them and neither parent present in the home. In 2012, Georgia had the 6th largest number of grandparents living with their grandchildren in the country. In Richmond and Columbia Counties alone, there are over 4,700 grandparents responsible for their grandchildren’s care. Almost 2,000 of those grandparents are raising their grandchildren without either parent present in the home and 27% have been raising their grandchildren for more than 5 years.
(32.8 %) Ellis & Simmons (2014)
Grandparents and Grandchildren
Demographic characteristics of grandparents and grandchildren are collected annually in the March Current Population Survey (CPS) for the Nation. More detail on other household and family characteristics for states, metropolitan areas, and other geographic areas is collected in the decennial census.
253,127 grandparents living in GA with their grandchildren
Of these, 224,606 live with grandparents who are the householders (9% of the children in the state)
The Grandparents*102,126 grandparents are the householders and are responsible for their grandchildren living
with them. Of these: 47% of the grandparents are White and not Hispanic, 46% are Black/African
American, 1% are Asian, 4% are Hispanic/Latino, and may be of any race.
o 41% have no parents of the children present in the home.
o 69% are under age 60.
o 25% live in poverty.**
AARP (2015); Ellis & Simmons (2014)

6. Children In The Care Of Grandparents
Data Provided by: National KIDS COUNT
Definitions: The share of children under age 18 living in households where a grandparent provides that child's primary care. 
Data Source: Population Reference Bureau, analysis of data from the U.S. Census Bureau, 2005 through 2015 American Community Survey.
Definitions: The share of children under age 18 living in households where a grandparent provides that child's primary care.  Any data accessed for this indicator before October 2011 may differ from the current tables.  In October 2011, the definition of the measure was slightly revised.
Data Source: Population Reference Bureau, analysis of data from the U.S. Census Bureau, 2005 through 2015 American Community Survey. These data were derived from American Fact Finder table B10002 (factfinder2.census.gov).
Footnotes: Updated October S - Estimates suppressed when the confidence interval around the percentage is greater than or equal to 10 percentage points.  N.A. – Data not available.  Data are provided for the 50 most populous cities according to the most recent Census counts.  Cities for which data is collected may change over time.  A 90 percent confidence interval for each estimate can be found at Children in the care of grandparents.
National Kids Count-The Annie E. Casey Foundation (2016)

7. REASON IN GRANDPARENT CARE
Child Abuse/Neglect
Drug/Alcohol Abuse
Physical and/or Mental Disease
Abandonment
Death of a Parent
Military Service
Teenage Parent
Incarceration

8. MAJOR HARDSHIPS FOR GRANDPARENT CAREGIVERS
Access to information
Lack of financial resources/living on fixed incomes
Social Isolation
Unfamiliar/frustrating systems including the school, mental health, legal, and healthcare system
Respite Care

9. MAJOR HARDSHIPS FOR GRANDPARENT CAREGIVERS
Mental health needs of the child and grandparents
No legal custody/access to legal system
Caring for children with special needs, both mental & physical
Childcare for working grandparents
Chronic Health Conditions

10. FUNDING
Established in January of 1999 through competitive renewal grants
DHR Promoting Safe & Stable Families Program (Family Support & Adoption Support)
Area Agency on Aging (Kinship/Respite Care)
25% Matching Funds from College of Nursing and Foundation Account

11. SERVICES PROVIDED BY THE PROGRAM
Case Management Services to help link families to a variety of community resources and information
Monthly Support Group Meetings
Monthly In-Home Health Screenings/Counseling
Child Custody/Adoption Assistance
Regular School Visits for children having behavior/academic problems
Community Resource Guide
To date,

12. SERVICES PROVIDED BY THE PROGRAM
Book Bags/School Supplies every school year
After-School Enrichment Funding
Summer Camp Funding
Pediatric Physicals
Annual Christmas Party
STUDENT NURSING INVOLVEMENT
CNL students design and implement a health intervention during one of the support group meetings in the spring for both the grandparents and the grandchildren. PNP & FNP students provide child health physicals during the month of July under the direction and supervision of CON Faculty.
CNL & PNP & FNP Health Intervention & Child Physicals
Book bags/School Supplies at the beginning of every school year
Pediatric Physicals
Annual Christmas Party 

13. FAMILIES SERVED BY THE PROGRAM
Nearly 2,000 grandparents are responsible for their grandchildren’s care in Richmond and Columbia Counties
Provided services to:
400 families
550 grandparents
870 children

14. FAMILIES SERVED BY THE PROGRAM
60% are headed by single grandmothers
Over 48% of grandparents are still in the workforce
Average age of grandparents when they began raising their grandchildren is 51
Average age of children when they began living with their grandparents is 4 ½
52% DFCS confirmed child abuse/neglect cases
Over 21% of children served by the program have a diagnosed mental health disorder including, but not limited to ADHD, ODD, depression, bipolar disorder, and schizophrenia. Over 5% of the children served by the program have been hospitalized for psychiatric treatment, some of whom have been victims of domestic violence within their parent’s home. Over 44% of children served have been diagnosed with a mental, physical, or neurological disorder. Just over 46% of children have no custody/legal relationship with their grandparents when entering the program.

15. FAMILIES SERVED BY THE PROGRAM
44% of children placed with their grandparents by DFCS
17% of children placed in foster care before coming to live with their grandparents
44% of children have been diagnosed with either a physical, mental or neurological disorder
47% of children had no legal relationship with their grandparents upon enrolling into the program
90% of children have little to no contact with their mother compared to 96% with their father
Over 21% of children served by the program have a diagnosed mental health disorder including, but not limited to ADHD, ODD, depression, bipolar disorder, and schizophrenia. Over 5% of the children served by the program have been hospitalized for psychiatric treatment, some of whom have been victims of domestic violence within their parent’s home. Over 44% of children served have been diagnosed with a mental, physical, or neurological disorder. Just over 46% of children have no custody/legal relationship with their grandparents when entering the program.

16. ASSESSMENT TOOLS North Carolina Family Assessment Scale
Family Empowerment Scale
Family Resource Scale
Family Support Scale
CES-D Scale
Modified Health Survey
Satisfaction Questionnaires
The North Carolina Family Assessment Scale (NCFAS) is used to administer a comprehensive child/family assessment and measures family function in the following domains: environment, parental capabilities, family interactions, family safety, and child well-being. The tool is administered during home visits and observations by the social worker.
Other tools are utilized during the initial assessment to collect pre-participation data on a number of different parameters including health, psychosocial, family dynamics, and empowerment. Each tool used represents multidimensional and interrelated factors related to family well-being. The Family Resource Scale (Ware & Sherbourne, 1992), Family Empowerment Scale (Koren, DeChillo, & Friesen, 1992), Family Support Scale (Dunst, Jenkins, & Trivette, 1984), CES-D Scale (Radloff, 1977), and the Health Survey are pre- and post-test standardized questionnaires completed by each family at the beginning of enrollment and at the end of their 12-month service period. Data from each questionnaire are entered into the Statistical Package for the Social Sciences (SPSS, version 18.0) for analysis. As a pre-test, the tools help to identify immediate needs the family may have. These tools are used in combination with interviews and program staff observations to help families identify their strengths and needs in order to develop their individualized case plan. Each showed a positive statistical difference from pre-test to post-test, with the most significant coming from the Family Empowerment Scale.
Along with staff observations, these tools are used to determine if there has been a positive statistically significant difference in the areas of family well-being, family stability, family support, family empowerment, family resources, home/environment safety, parent and child health, as well as grandparent’s depression.
Satisfaction questionnaires will also be used to determine responsiveness of targeted services and evaluate the delivery of services. Grandparents are given many opportunities, both during and after the service period, to critique and assess targeted services provided by the program and the manner in which they are delivered.
Staff observations of family functioning including the consistent use of proper discipline techniques, coping with family stress in an effective manner, accessing community resources, and an increase in child educational achievement will also be measured. The program will evaluate other determining factors for program success including whether or not there were any initial or subsequent child neglect/abuse reports, whether the family has met all of their case plan goals, whether families have expanded their referral base and support system, and whether there have been any subsequent alternative placements for children.

17. Provide Permanency & Stability in Children’s Lives
GOALS
Provide Permanency & Stability in Children’s Lives
Prevent Children from Entering or reentering the formal foster care system
Empower families to become more independent
Expand families’ support system
Increase/maintain school achievement
Reduce risk of child maltreatment
Enable grandparents to effectively cope with family stress
ADVOCACY EFFORTS
• We are currently working with local legislators to make changes to the Georgia Juvenile Code that would ultimately make it easier for grandparents to have access to the juvenile court system and petition the court for legal custody of their grandchildren.
• In August of 2016, we began collecting school data to study the educational performance and outcomes of grandchildren raised by their grandparents who have enrolled in the Healthy Grandparents Program.
Purpose: Compare educational performance & outcomes to those children in foster care. Less likely to experience behavior problems, psychiatric disorders, school disruptions, placement disruptions, and adjust better to their new environment, eases trauma or separation, more stability, maintain contact with siblings, maintain community bonds/familiarity

18. OUTCOMES 93% of children have remained in their grandparents care
4% went to live with other relatives other than their parents after the death of the grandparent
Reduced non-custodial arrangements by almost 25%
Established full legal custody/adoption for 27% of children served by the program (234)
Increased adoptions by 13%

19. OUTCOMES Reduced children with no health insurance by 8%
High graduation rates, school attendance rates
Low teenage pregnancy rates and juvenile crime rates
Positive statistically significant change from pretest to posttest on all tools (p<.01 to p<.05)
Family Empowerment Scale showed the greatest positive increase
Family Empowerment Scale (FES)
Positive statistically significant change from pretest to posttest on all tools (p<.01 to p<.05)
Family Empowerment Scale showed greatest change
Scoring is based on a simple, unweighted summation of the items within three construct areas:
family (2, 4, 7, 9, 16, 21, 26, 27, 29, 31, 33, 34)
service system (1, 5, 6, 11,12, 13, 18, 19, 23, 28, 30, 32)
community/political (3, 8, 10, 14, 15, 17, 20, 22, 24, 25)
Koren, P.E., DeChillo, N., & Friesen, B.J. Family Empowerment Scale (FES)
Variables measured: Levels of empowerment of the family or of other caregivers of children with emotional problems.
Type of instrument: Questionnaire
Samples measured: The authors indicate the FES applies primarily to parents and caregivers of children with emotional disabilities ages 6 to 18, although it has been adapted for use with other populations.
Instrument Description: The FES is a 43-item Likert-type questionnaire that evaluates levels of empowerment experienced by parents or other caregivers of children with emotional difficulties.

20. ADVOCACY Recommended changes to the juvenile code
KINSHIP DAY AT THE CAPITAL 2016
Recommended changes to the juvenile code
Educational Outcomes of Children Raised by Grandparents Enrolled in the Healthy Grandparents Program
KINSHIP DAY AT THE CAPITAL 2016Educational achievement/outcome study

21. North Carolina Family Assessment Scale (Kirk, R.)
Family Empowerment Scale (Koren, DeChillo, & Friesen, 1992)
The Family Resource Scale (Dunst, C. J., & Leet, H. (1987).
Family Support Scale (Ware & Sherbourne, 1992)
CES-D Scale (Radloff, 1977)
Modified Health Survey
Satisfaction Questionnaires
The Annie E. Casey Foundation, KIDS COUNT Data Center, datacenter.kidscount.org
AARP GrandFacts for Georgia. (2015). State fact sheets for grandparents and other relatives raising grandchildren. Retrieved from
Ellis, R. & Simmons, T. (2014). Co-resident grandparents and their grandchildren: 2012 Population characteristics (P20-576). Washington, DC: U.S. Census Bureau. Retrieved from
Georgia House of Representatives. (2015). Study committee on grandparents raising grandchildren and kinship care: Final report. Retrieved from
U.S. Department of Commerce, Economics and Statistics Administration, U. S. Census Bureau.
U.S. Department of Commerce, U. S. Census Bureau. American Community Survey (ACS) (2014). Retrieved from