The Problem: Needs at the Family-Level

Children face caregiving disruptions as a result of family adversity, often related to poverty, neglect, maltreatment, or contact with the criminal justice system 16 . The disruption in the caregiving placement constitutes an additional source of acute stress, and sometimes trauma, for the child and the family. Relatives responding to the need to care for the affected child take on new roles and responsibilities that they were unprepared for and often struggle with the resulting complexities of these new roles. For instance, kinship families experience issues with generational gaps, family loyalty, guilt and conflict regarding contact with birth parents 17 .  In addition, kinship caregivers may underplay the behavioral difficulties of the children in their care 18 , potentially due to lack of trust of service providers or fear that further involvement with the child welfare system may jeopardize the placement 19 20 . Underreporting behavioral difficulties can result in missed opportunities for early intervention, which are particularly important given the multifaceted needs faced by children in kinship care 21 . 
 
On the other hand, adoptive families often face a different set of complex dynamics. Difficulties may not emerge until specific developmental periods that fall outside the range of post-adoption support services. Conflicts in adoptive families are more likely to arise when the child reaches adolescence, which may be years after the finalization of the adoption 22 .  Discerning differences in normative adolescent conflict from adoption-related issues can be of particular importance in these scenarios, yet families struggle to find providers that are specialized in issues of adoption 23 .  This is a significant failed opportunity, given that adoptive parents stand to benefit substantially from understanding and learning to manage the child’s difficult behaviors, even if the behaviors themselves do not change 24 .

Despite the prevalence of these complex family dynamics, kinship caregivers lack information about services available to address them 25 26 . Kinship caregivers may not be aware of their eligibility for certain programs and have lower expectations of assistance from child welfare compared to unrelated caregivers, especially when these families were formed via informal arrangements. Research has shown that kinship caregivers’ lack of knowledge about resources moderates their children’s access to needed mental health services, even when child welfare caseworkers are involved. Accordingly, recent initiatives have emphasized family engagement as a critical feature of programs for kinship families and recommended using public media campaigns, school-based programs, and health care and community professionals to promote engagement. Moreover, psychoeducation and navigation services can be especially effective to connect families with mental health services 27 . 

Similarly, many adoptive families lack knowledge of the services that they are eligible for post-adoption 28 .  Whereas pre-adoption services are often expected and available, families’ need for services may not emerge until specific developmental periods or the occurrence of stressful events that may take place years after the adoption is finalized, after the connections to services have dissipated 29 .  Therefore, researchers and practitioners have advocated for programs that provide a continuous model for follow-up and maintained connections to providers 30 .

Another long-recognized barrier that keeps both kinship and adoptive families from services is social stigma, particularly regarding mental health services. For instance, kinship caregivers may worry that the child’s emotional or behavioral difficulties may be interpreted as a personal failure of the caregiver and may prompt increased involvement with the child welfare system or compromise the child’s placement 31 32 . Adoptive caregivers also report feeling stigma, albeit in different forms. Weistra and Luke (2017) report that adoptive caregivers felt misunderstood by non-adopters and misrepresented as “heroes” or “desperate” by the media 33 .   Normalization of these families’ unique dynamics and difficulties and of seeking services to address them can facilitate improved service access 34 . 

Additionally, systemic issues can exacerbate barriers to accessing services for families of color and of lower socio-economic status 35 .  Studies have repeatedly shown that Black and Latino youth with both kinship and non-related caregivers are less likely than White children to receive recommended mental health services 36 37 38 .  Moreover, kinship caregivers of color and of lower socio-economic status are less likely to access needed medical and mental health services for themselves, even though they experience greater need for these services than their white and higher income counterparts 39 .  Although the intersection of race, socio-economic status, and geographical location makes it difficult to disentangle the reasons for lower service utilization, studies suggest that negative and stigmatizing experiences with services providers may be, at least partly, responsible for these disparities 40 41 . Importantly, Schneiderman and colleagues found that when Black kinship caregivers faced difficulty with access to services, they sought help from their social networks 42 . Understanding how cultural factors influence the use of formal and informal services among kinship families of color is essential to increasing their access to adequate supports. Moreover, assessing the presence and magnitude of providers’ stigma towards the families they serve may be useful to identify and address areas for organizational training and service improvement 43 .

• 16ong, K. (2017). Children Services involvement and contexts of poverty: The role of parental adversities, social networks, and social services. Children and youth services review, 72, 5-13.
• 17Smithgall, C., Mason, S., Michels, L., LiCalsi, C., & George, R. (2009). Intergenerational and interconnected: Mental health and well-being in grandparent caregiver families. Families in Society, 90(2), 167–175. http://dx.doi.org/10.1606/1044–3894.3869.
• 18Rosenthal, J. A., & Curiel, H. F. (2006). Modeling behavioral problems of children in the Children Services system: Caregiver, youth, and teacher perceptions. Children and Youth Services Review, 28(11), 1391-1408.
• 19Coleman, K. L., & Wu, Q. (2016). Kinship care and service utilization: A review of predisposing, enabling, and need factors. Children and Youth Services Review, 61, 201-210.
• 20Berrick, J. D., Barth, R. P., & Needell, B. (1994). A comparison of kinship foster homes and foster family homes: Implications for kinship foster care as family preservation. Children and Youth Services Review, 16, 33–63.
• 21Breman, R. (2014). Peeling back the layers–kinship care in Victoria: Research Report. Camberwell, Victoria: Baptcare. Retrieved from https://core.ac.uk/download/pdf/30673587.pdf
• 22 Stevens, K. (2011). Post-Adoption Needs Survey Offers Direction for Continued Advocacy Efforts, Adopttalk. North Council on Adoptable Children.
• 23Rolock, N., Bader, H., Diamant-Wilson, R., Blakey, J., Zhang, L., White, K., Cho, Y., Fong, R. (2019). Evaluation results from Wisconsin-Final evaluation report. In Rolock, N. & Fong, R. (Eds.). Supporting adoption and guardianship: Evaluation of the National Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG)-Final evaluation report. (pp. 7-1 – 7-68). Washington, DC: Department of Health and Human Services, Administration for Children and Families, Children’s Bureau.
• 24AdoptUsKids (2015). Support Matters: Lessons from the field on services for adoptive, foster, and kinship care families. Retrieved from: http://adoptuskids.org/_assets/files/AUSK/support- matters/support-matters-resource-guide.pdf
• 25Children Services Information Gateway (2019). Children’s Bureau Grantee Synthesis: Kinship Navigation Programs. Retrieved from https://www.childwelfare.gov/pubPDFs/kinshipnavigator.pdf
• 26 Coleman, K. L., & Wu, Q. (2016). Kinship care and service utilization: A review of predisposing, enabling, and need factors. Children and Youth Services Review, 61, 201-210.
• 27Smithgall, C., Yang, D., & Weiner, D. (2013). Unmet mental health service needs in kinship care: The importance of assessing and supporting caregivers. Journal of Family Social Work, 16(5), 463–479. http://dx.doi.org/10.1080/10522158.2013.832460.
• 28Dhami, M. K., Mandel, D. R., & Sothmann, K. (2007). An evaluation of post-adoption services. Children & Youth Services Review, 29(2), 162-179.
• 29Stevens, K. (2011). Post-Adoption Needs Survey Offers Direction for Continued Advocacy Efforts, Adopttalk. North Council on Adoptable Children.
• 30Rolock, N., Bader, H., Diamant-Wilson, R., Blakey, J., Zhang, L., White, K., Cho, Y., Fong, R. (2019). Evaluation results from Wisconsin-Final evaluation report. In Rolock, N. & Fong, R. (Eds.). Supporting adoption and guardianship: Evaluation of the National Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG)-Final evaluation report. (pp. 7-1 – 7-68). Washington, DC: Department of Health and Human Services, Administration for Children and Families, Children’s Bureau.
• 31Coleman, K. L., & Wu, Q. (2016). Kinship care and service utilization: A review of predisposing, enabling, and need factors. Children and Youth Services Review, 61, 201-210.
• 32 Gladstone, J. W., Brown, R. A., & Fitzgerald, K. J. (2009). Grandparents raising their grandchildren: Tensions, service needs and involvement with Children Services agencies. International Journal of Aging and Human Development, 69(1), 55–78. http://dx.doi. org/10.2190/AG.69.1.d.
• 33Weistra, S., & Luke, N. (2017). Adoptive parents’ experiences of social support and attitudes towards adoption. Adoption & Fostering, 41(3), 228-241.
• 34Wang, K., Link, B. G., Corrigan, P. W., Davidson, L., & Flanagan, E. (2018). Perceived provider stigma as a predictor of mental health service users' internalized stigma and disempowerment. Psychiatry Research, 259, 526-531.
• 35Szolnoki, J., & Cahn, K. (2002). African American kinship caregivers: principles for developing supportive programs. Northwest Institute for Children & Families, 4(5), 1-15.
• 36Staudt, M. M. (2003). Mental health services utilization by maltreated children: Research findings and recommendations. Child Maltreatment, 8(3), 195–203. http://dx.doi.org/ 10.1177/1077559503254138.
• 37James, S., Landsverk, J., Slymen, D. J., & Leslie, L. K. (2004). Predictors of outpatient mental health service use—The role of foster care placement change. Mental Health Service Research, 6(3), 127–141. http://dx.doi.org/10.1023/B:MHSR.0000036487.39001.51.
• 38Petrenko, C. L. M., Culhane, S. E., Garrido, E. F., & Taussig, H. N. (2011). Do youth in out-of- home care receive recommended mental health and educational services following screening evaluations? Children and Youth Services Review, 33(10), 1911–1918. http://dx.doi.org/10.1016/j.childyouth.2011.05.015.
• 39Coleman, K. L., & Wu, Q. (2016). Kinship care and service utilization: A review of predisposing, enabling, and need factors. Children and Youth Services Review, 61, 201-210.
• 40Chambers, J. E., & Ratliff, G. A. (2019). Structural competency in Children Services: Opportunities and applications for addressing disparities and stigma. J. Soc. & Soc. Welfare, 46, 51.
• 41Kennedy, S. C., Miller, C., & Wilke, D. (2020). Development and validation of the Children Services Provider Stigma Inventory. Journal of Social Work, 20(6), 703-729.
• 42Schneiderman, J. U., Smith, C., & Palinkas, L. A. (2012). The caregiver as gatekeeper for accessing health care for children in foster care: A qualitative study of kinship and un- related caregivers. Children and Youth Services Review, 34, 2123–2130. http://dx.doi. org/10.1016/j.childyouth.2012.07.009.
• 43Kennedy, S. C., Miller, C., & Wilke, D. (2020). Development and validation of the Children Services Provider Stigma Inventory. Journal of Social Work, 20(6), 703-729.