[Senate Hearing 115-362]
[From the U.S. Government Publishing Office]
S. Hrg. 115-362
GRANDPARENTS TO THE RESCUE:
RAISING GRANDCHILDREN IN THE OPIOID
CRISIS AND BEYOND
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
MARCH 21, 2017
__________
Serial No. 115-2
Printed for the use of the Special Committee on Aging
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
28-601 PDF WASHINGTON : 2018
SPECIAL COMMITTEE ON AGING
SUSAN M. COLLINS, Maine, Chairman
ORRIN G. HATCH, Utah ROBERT P. CASEY, JR., Pennsylvania
JEFF FLAKE, Arizona BILL NELSON, Florida
TIM SCOTT, South Carolina SHELDON WHITEHOUSE, Rhode Island
THOM TILLIS, North Carolina KIRSTEN E. GILLIBRAND, New York
BOB CORKER, Tennessee RICHARD BLUMENTHAL, Connecticut
RICHARD BURR, North Carolina JOE DONNELLY, Indiana
MARCO RUBIO, Florida ELIZABETH WARREN, Massachusetts
DEB FISCHER, Nebraska CATHERINE CORTEZ MASTO, Nevada
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Kevin Kelley, Majority Staff Director
Kate Mevis, Minority Staff Director
CONTENTS
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Page
Opening Statement of Senator Susan M. Collins, Chairman.......... 1
Statement of Senator Robert P. Casey, Jr., Ranking Member........ 2
PANEL OF WITNESSES
Videotape Statement of Ann Sinsheimer and Marvin Sirbu,
Grandparents, Pittsburgh, Pennsylvania; Linda James,
Grandparent, Rochester, New York; and Belinda Howard,
Grandparent, Fort Walton, Florida.............................. 6
Jaia Peterson Lent, Deputy Executive Director, Generations
United, Washington, DC......................................... 7
Megan L. Dolbin-MacNab, Ph.D., LMFT, Associate Professor,
Department of Human Development, Director, Marriage and Family
Therapy Doctoral Program, Faculty Affiliate, Center for
Gerontology, Virginia Tech Faculty of Health Sciences, Virginia
Tech, Blacksburg, Virginia..................................... 9
Bette Hoxie, Executive Director, Adoptive and Foster Families of
Maine and the Kinship Program, Orono, Maine.................... 11
Sharon McDaniel, MPA, Ed.D., President and Chief Executive
Officer, A Second Chance, Inc., Pittsburgh, Pennsylvania....... 13
APPENDIX
Prepared Witness Statements and Questions for the Record
Jaia Peterson Lent, Deputy Executive Director, Generations
United, Washington, DC......................................... 34
Jaia Peterson Lent Response to Questions for the Record...... 38
Megan L. Dolbin-MacNab, Ph.D., LMFT, Associate Professor,
Department of Human Development, Director, Marriage and Family
Therapy Doctoral Program, Faculty Affiliate, Center for
Gerontology, Virginia Tech Faculty of Health Sciences, Virginia
Tech, Blacksburg, Virginia..................................... 40
Bette Hoxie, Executive Director, Adoptive and Foster Families of
Maine and the Kinship Program, Orono, Maine.................... 56
Sharon McDaniel, MPA, Ed.D., President and Chief Executive
Officer, A Second Chance, Inc., Pittsburgh, Pennsylvania....... 57
Sharon McDaniel Response to Questions for the Record......... 59
GRANDPARENTS TO THE RESCUE:
RAISING GRANDCHILDREN IN THE
OPIOID CRISIS AND BEYOND
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TUESDAY, MARCH 21, 2017
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 2:30 p.m., in
Room SD-562, Dirksen Senate Office Building, Hon. Susan M.
Collins (Chairman of the Committee) presiding.
Present: Senators Collins, Fischer, Casey, Gillibrand,
Donnelly, Warren, and Cortez Masto.
OPENING STATEMENT OF SENATOR SUSAN M. COLLINS, CHAIRMAN
The Chairman. The Committee will come to order.
Good afternoon and welcome. This hearing was originally
scheduled for last week, as our witnesses know well, but winter
does not always cooperate with our Senate schedules.
I am particularly pleased to welcome today one of the new
members of our Committee, Senator Fischer from Nebraska. I was
absolutely delighted when I learned she would be joining our
Committee, so thank you, Senator, for being here.
This hearing focuses on an important topic, and I am very
pleased that we have gathered here to discuss it today. Last
year, nearly 1,000 babies in Maine--that is about 8 percent of
all births--were born to women addicted to opioids and other
drugs. This tragedy afflicts many other states as well as mine.
In the United States, every 25 minutes a baby is born with an
opioid addiction. In this crisis, as in past crises,
grandparents are coming to the rescue. The Aging Committee is
meeting today to recognize the grandparents raising grandkids
and to explore what can be done to assist them as they take on
this unanticipated challenge motivated by their love of their
grandchildren.
One in five grandparents provides child care regularly to
their grandchildren. In fact, grandparents who help raise
grandkids together with the child's parents can support healthy
aging and be a positive experience for all concerned. Today,
however, we are focusing on grandparents who are raising their
grandchildren alone. These ``custodial grandparents'' are
called on to help for a number of reasons, including alcohol
and drug addiction, physical abuse, incarceration, divorce,
financial difficulties, military deployment, and even death. In
Maine, the number of children being raised solely by their
grandparents increased by 24 percent between 2010 and 2015.
At a time in life when most seniors are looking forward to
enjoying more leisure time, these grandparents have found
themselves as parents once again. They are waking up in the
middle of the night to feed babies and planning afternoons
around soccer practice, rather than playing golf or
volunteering.
Raising a second family also involves costs they had never
anticipated as they budgeted for what was supposed to be their
golden years. They are tapping into retirement savings, going
back to work, or staying in the workforce longer just to make
ends meet.
In addition to the financial toll, raising children later
in life presents social, emotional, legal, and other
challenges. It can be socially difficult to become a full time
caregiver as an older adult, often isolated from friends. It
can be emotionally difficult to go from being a grandmother who
spoils the kids to becoming the disciplinarian who makes sure
that homework is finished.
At the same time, it can often be emotionally difficult to
navigate the relationship with the children's birth parents.
The legal challenges are tough. The process of attaining
custody is complex, lengthy, and costly. Without a proper legal
arrangement, routine tasks such as enrolling kids in school or
obtaining medical care can be difficult.
Becoming a full-time caregiver can also take a toll on the
health of the grandparent. The new caregiver role challenges
both the physical, mental, and emotional health of grandparents
resulting in higher rates of diabetes, heart disease, and
depression.
Despite all of these challenges, when asked if they regret
taking on the caregiver role, a vast majority of these
grandparents answer, ``No.'' They know that they are making a
difference. They are providing love, stability, and a home to
children who might otherwise have to live with strangers.
WABI, the CBS television station in Bangor, Maine, recently
featured stories of grandparents raising their grandchildren.
What struck me the most in those stories was that the
grandparents are not focused on the challenges; instead, they
are focused on their love for their grandchild. As one put it,
``In the end, it is worth it to know that they are happy and
safe.''
Throughout history, grandparents have stepped in to provide
safe and secure homes to their grandchildren, replacing
traumatic pasts with loving and hopeful futures. The opioid
crisis has called upon grandparents in epic numbers. We are
here today to focus on what is being done to help those
grandparents who have stepped up to help ensure a better life
for their children's children.
Senator Casey, it is delightful to have you here today, and
I call upon you for your opening remarks.
OPENING STATEMENT OF SENATOR ROBERT P. CASEY, JR., RANKING
MEMBER
Senator Casey. Chairman Collins, thank you very much, and
thanks for getting us started on this important issue.
I want to thank the Chairman for calling this hearing, and
as she just indicated, today's topic is indeed challenging, and
that is an understatement. It is one that we both see back
home, and I think that is true of every member of this
Committee. And it is one that motivates us when we are here in
Washington to try to focus on this issue and to tackle the
problem.
Grandparents Ann Sinsheimer and Marvin Sirbu joined me at a
hearing recently, at a gathering in Pittsburgh, on the opioid
problem in the city of Pittsburgh. And as you will hear from
them shortly, they are raising their grandchildren because
their daughter is struggling with an opioid addiction. Ann and
Marvin are here with us today. Where are they? Oh, I did not
see you coming in. I am sorry. Ann and Marvin are with us, and,
Ann and Marvin, we want to first of all express our gratitude
to you for being here again after having appeared in Pittsburgh
and for giving a voice to grandparents across the country who
are caring for their grandchildren under the hardest of
circumstances.
I also look forward to introducing Dr. Sharon McDaniel from
Pittsburgh as part of our panel today. I will do that
introduction a little later, but we are grateful that Dr.
McDaniel is here.
And like the State of Maine, the State of Pennsylvania has
been hit hard by the opioid epidemic. More than 3,200
Pennsylvanians died from drug overdoses just in 2015 alone.
That is a 20-percent increase over the 2014 total.
As the Centers for Disease Control and Prevention tell us,
the majority of these drug overdoses are caused by opioids. The
reality is that opioid addiction is devastating the lives of
individuals with addiction. It is also putting a strain on our
health care system, law enforcement, and communities across the
country as well.
It is also taking a toll on families. Too often, moms and
dads are falling victim to the epidemic, and grandparents are
stepping in to care for the children. That is one of the
reasons why the number of children being raised by grandparents
is on the rise. In Pennsylvania, 103,000 children--103,000
children--are in the care of their grandparents or other
relatives. Experts point to opioids as the major driver of that
growth, and any parent will tell you that raising a child is
rewarding indeed, and it is fulfilling. But it is also a major
challenge.
For grandparents, it can dramatically alter their life
plans, as Senator Collins noted. They postpone retirement. They
keep working longer to be able to afford clothes, child care,
and food. Some deplete their nest eggs and retirement savings
to finance these new costs. Many are isolated from their social
networks.
Raising children of a parent struggling with addiction
presents additional challenges for grandparents. Often, they
spend time in court struggling to sort out custody. Frequently,
they need to learn the special education system to get their
grandchildren the supports that they need.
Children of addicted parents have often experienced trauma
and have been exposed to violence and drug use, so grandparents
must address a child's mental health needs. And they may need
to help the child navigate their relationship with the parent
who is still using opioids.
All of this can be overwhelming when you expected the next
phase of your life to be retirement, and it takes a tool on the
grandparents' physical and mental health. These are all
significant challenges for the grandparents, but, of course,
most grandparents say that it is all worth it to have the peace
of mind knowing that their grandchildren are safe. Grandparents
stepping up to take on the role of primary caretaker of their
grandchildren deserve our support. They should not feel
isolated and unaware or unsure of where to turn for help.
There are supports like the National Family Caregiver
Support Program, which is under the Older Americans Act. This
program helps ``grandfamilies''--a new term--by providing
caregivers counseling and respite care. With grandfamilies on
the rise, ensuring adequate federal funding is critical.
There is also the modest child-only TANF funding that
families can access, Temporary Assistance for Needy Families.
But there is not a go-to place for older Americans facing this
situation, and with more and more seniors taking on this role,
we need to be thinking about how to better serve them.
That is why I would like to work with Chairman Collins and
others on legislation to create a one-stop shop for everyone
trying to help grandparents raising their grandchildren to help
make their job a little bit easier.
We also need to continue to expand access to treatment. I
am pleased, like we all are, that we provided $1 billion in
funding to states over the next two years to combat the opioid
epidemic as part of the 21st Century Cures bill at the end of
the year. That is the good news.
The bad news? This funding and other funding like it will
be undermined if the Affordable Care Act is repealed. Just that
repeal alone would remove at least $5.5 billion annually from
the treatment of those with mental health and substance use
disorders. So $5.5 billion could be gone even though the $1
billion was added at the end of last year. We cannot allow that
to happen.
At the height of this epidemic, we cannot lose ground on
health care coverage. It is too important to every generation--
grandparent, parent, and child. So I am committed to fight to
ensure that we maintain these vital programs that today help
older Americans and grandparents who are raising their
grandchildren.
Today's hearing will help us learn from past experiences,
including issues faced by grandparents affected by the crack
cocaine epidemic in the 1980s and 1990s. We cannot arrest our
way out of the opioid epidemic, and treatment matters, good
treatment matters, so that grandparents can be grandparents,
and grandchildren can once again be grandchildren.
I look forward to hearing from our witnesses about how we
can do that important task. Thanks very much.
The Chairman. Thank you very much, Senator.
Now we will turn to our witnesses. First, we will hear, by
video, from grandparents who are raising their grandchildren.
As Senator Casey has already previewed, two members of our
audience today are featured also in the video. Drs. Ann
Sinsheimer and Marvin Sirbu from Pittsburgh, Pennsylvania, will
tell their story. Mrs. Linda James will share her story from
Rochester, New York. And, last, we will hear from Mrs. Belinda
Howard, who is from Fort Walton, Florida.
Next we will hear from our panel that is right in front of
us, and that includes Jaia Lent. Ms. Lent is the deputy
executive director of Generations United. She leads work for
the National Center on Grandfamilies. That was a new phrase for
me also.
We will then hear testimony from Dr. Megan Dolbin-MacNab,
an associate professor of human development at Virginia Tech.
She is also director of the Marriage and Family Therapy
Doctoral Program.
We will next, I am delighted to say, hear from one of my
constituents, Bette Hoxie. Mrs. Hoxie is the executive director
of Adoptive and Foster Families of Maine and the Kinship
Program. Adoptive and Foster Families of Maine provides
important services to grandparents, including kinship training,
licensing and legal support, material support, and respite
care. Mrs. Hoxie does tremendous work to support grandfamilies
in Maine. I would note that I recognized her with the Angels in
Adoption Award in 2004, and I am delighted that she has joined
us today. She has personally raised some 19 children, which is
truly extraordinary, and she is still at it.
I will now turn to our Ranking Member to introduce our
final witness on this panel, Dr. Sharon McDaniel.
Senator Casey. Chairman Collins, thank you.
Dr. Sharon McDaniel is the founder, president, and chief
executive officer of A Second Chance in Pittsburgh,
Pennsylvania. Dr. McDaniel is an alumna of foster care herself
and was raised by relatives. She founded A Second Chance, which
is a nonprofit that provides services to 800 families a day
through kinship care in both Pittsburgh and Philadelphia, our
two largest cities in the State. A Second Chance's mission is
to provide a safe and nurturing environment to children who are
being cared for by their relatives. It also works to prevent
the cycle of drug and alcohol abuse and provide children in
need with kinship placement. Dr. McDaniel is also a member of
the Casey Family Programs Board of Trustees. No relation to me,
but a great organization, great foundation.
Clearly, Dr. McDaniel's work and that of A Second Chance is
invaluable to the people of Pennsylvania, so I am glad she is
here with us today, and I look forward to her testimony.
I mentioned Ann and Marvin, as the Chairman did. They will
be in the video. They will not be giving testimony, but they
are here. So they are here in more ways than one, both in the
video and in person. We are grateful they drove from Pittsburgh
to be here. And as I mentioned, they have taken on this task of
raising two granddaughters as a result of their mom's struggle
with drug addiction. So they have made great sacrifices not
only to be here but, of course, the larger sacrifice they have
taken on. So thanks very much.
The Chairman. Thank you, Senator.
I would now direct your attention to the screens where we
will hear the testimony of individual grandparents.
VIDEOTAPE STATEMENT OF ANN SINSHEIMER AND MARVIN SIRBU,
GRANDPARENTS, PITTSBURGH, PENNSYLVANIA; LINDA JAMES,
GRANDPARENT, ROCHESTER, NEW YORK; AND BELINDA HOWARD,
GRANDPARENT, FORT WALTON, FLORIDA
Ms. Sinsheimer. Hi. We are Ann and Marvin, and we are
caring for our two granddaughters, ages 8 and 5.
Mr. Sirbu. Well, I have a daughter who has been struggling
with drug addiction for a dozen years. Well, I am 71. I had
been thinking about when I would retire, but now I am thinking
it is going to be later than I originally thought. I need
health insurance for my oldest granddaughter, and I can get
that through my employer if I continue working. And my
expenditures are more than anticipated, and so it seems prudent
to continue working a little longer.
I have colleagues with young kids, but they are much
younger than I am, and the people who I have associated with
all my career are now themselves empty nesters. They are
talking about their grandchildren, but only for occasional
visits. And so it is a little awkward. The people I would
normally socialize with do not want to talk about young kids
anymore. And the people with young kids are in a different
stage of life than we are. So it is a bit awkward.
Ms. Sinsheimer. Yeah. It is hard to go out. It is hard to
make plans to travel, like we were thinking about, and I guess
sometimes I feel like it is a little lonely. I feel a little--I
mean, I know I should not, but I feel a little ashamed about
our situation. It is not like something you want to bring up at
dinner when you are actually going out with your friends. So we
are in such a different world from our peers.
Ms. James. I am Linda James, and I have raised two of my
grandchildren. I became a primary caregiver of my grandchildren
in 1987 when my granddaughter was born in a crack house. Two
years later, I went to Baltimore, Maryland, to pick up my
grandson. Well, I started a support group because I felt that
the kinship caregivers needed that emotional support. And they
also needed tools to help them in raising their grandkids,
tools such as how to navigate the special education system
because a lot of children whose parents have been affected by
drugs have some learning disabilities. So these grandparents
need to know how to navigate their special education system.
They also need to know how to take some of the old things
that they have learned when they was growing up and applying
some of the new things that we are now doing to really help
their grandchild and to really understand their grandchild.
Well, the skills that I found most helpful was really just good
parenting skills and good common sense.
Ms. Howard. Hi. My name is Belinda Howard, and I am from
Fort Walton Beach, Florida, and I am raising our grandson,
Logan. He is seven years old. So we rescue the children from
foster care, and they have been in our home ever since.
We are back in the public school system, and that is a big
challenge. I thought I was done with that. So, financially, for
my husband and me it is a challenge. You know, there is
baseball equipment and basketball equipment and school lunches
and just the time and, you know, not having that time frame
where we feel like we were going to be empty nesters, and we
are not. So that is a huge challenge.
Being a part of an online support group through the
Addict's Mom, called ``Grandparent to Grandparent,'' I want to
say we are at 2,900 members strong, and it is good to have
online support. But if we could have people-to-people support,
you know, something on the ground, groups that we could go to,
people that we could touch and help and, you know, encourage
each other, that would be huge, you know, to just be able to
know that there are other grandparents out there, you know, for
whatever reason, struggling to take care of their grandkids.
The most positive thing from this situation--because my
husband and I have four children and three of them are addicts,
we have eight grandchildren, and I want to say the most
positive thing about everything is that our--our grandchildren
think we're super heroes. They think that their Gammy and Pop-
Pop can do everything.
[End of videotape.]
The Chairman. Well, I think the grandparents who are
raising grandchildren are super heroes. I think she said it
very, very well, and that is something all of us can admire.
We are now going to start with testimony from our panel,
and, Ms. Lent, we will begin with you.
STATEMENT OF JAIA PETERSON LENT, DEPUTY EXECUTIVE DIRECTOR,
GENERATIONS UNITED, WASHINGTON, DC
Ms. Lent. Thank you, Chairwoman Collins, Ranking Member
Casey, and members of the Committee, for your leadership in
holding this hearing on the important role of grandparents in
providing safe and stable homes to children and the sharp
increase in this trend attributed to the opioid crisis.
For almost 20 years, Generations United's National Center
on Grandfamilies has been a leading voice for issues affecting
families headed by grandparents and other relatives.
Today's grandparents provide a continuum of care from part-
or full-time child care to raising a grandchild. My testimony
will focus on grandparents and other relatives raising
children, also known as ``grandfamilies.''
According to the U.S. census, more than 2.6 million
grandparents report they are responsible for their
grandchildren. And there are many kinds of grandfamilies. Some
grandparents are raising children inside the formal foster care
system as licensed or unlicensed kinship foster parents. Others
have no involvement or support from the child welfare system.
And while the challenges these families face are varied and
complex, they are united by one common factor: they believe
beyond a shadow of a doubt in the importance of family. They
believe that children fare better when they are raised in a
family, not a system, and they are right. Yet we cannot ignore
the fact that they often step in at great personal sacrifice,
impacting their own health, family relationships, and financial
well-being.
My testimony focuses in four areas: the impact of the
opioid epidemic on grandparents; the critical role
grandfamilies play in helping the children thrive; the
importance of supportive services to help grandfamilies
succeed; and the valuable role that the National Family
Caregiver Support Program can play in responding to the crisis.
After years of decline, the overall numbers of children in
foster care are on the rise. Child welfare systems are
increasingly looking to grandparents and other relatives to
care for children as they face shortages of foster parents to
meet the growing need. And unlike parents or foster parents who
plan for months or even years to care for a child, these
grandparents usually step into their role unexpectedly. Some
may have received a call in the middle of the night telling
them to come and pick up their grandchildren or they will end
up in foster care. Suddenly, they are forced to navigate
complex systems to help meet the challenges of the children who
come into their care, often after experiencing significant
trauma.
Taking on the unexpected expense of a child can be
especially devastating to caregivers living on fixed incomes.
Countless grandfamilies report spending down their retirement
savings to address the health, mental health, food and clothing
needs of the children, or to pay expenses from seeking legal
custody of the children.
And while grandparents have been called upon to raise
children for many reasons over the years, the current opioid
and heroin epidemic is overwhelming many families and child
welfare systems.
One grandparent shined a light on the impact when she said,
``For my 50th birthday, I got a two-year old. My story is not
unique. The opioid epidemic has devastated communities all over
the country. It does not discriminate against age, race, or
gender. It affects all of us.''
In 2014, more than a third of all children who were removed
from their homes because of parental alcohol or drug use were
placed with relatives. And although the child welfare system
relies heavily on relatives, for every child being raised
inside the foster care system with a relative, there are 20
children being raised in grandfamilies outside of the foster
care system. And those that raise children outside of the
system usually struggle with even less support.
Despite the challenges facing grandfamilies, children fare
well in the care of relatives. Compared to children in non-
relative care, they have more stability, are less likely to run
away, are more likely to report feeling loved. When children
cannot remain with their parents, research shows that placing
children in grandfamilies reinforces stability, safety, well-
being, and a child's sense of identity, reduces trauma, helps
keep brothers and sisters together, honors family and cultural
ties, and it increases the likelihood of having a permanent
home.
A young person may age out of a system, but they never age
out of a family.
Families face challenges that can be addressed through key
supports such as information and referral services like Kinship
Navigator Programs and support groups; physical and mental
health care, including Medicaid; affordable legal services;
lifespan respite care; financial supports such as Temporary
Assistance for Needy Families and Social Security. And,
finally, the National Family Caregiver Support Program can also
play a valuable role in helping to respond to the crisis.
Current law gives states the option to use up to 10 percent
of their National Family Caregiver Support Program dollars to
serve grandfamilies, yet only seven states use the full 10
percent to serve the families; however, those who do, report a
significant impact.
A full list of Generations United's recommendations are
included in my written testimony, including the importance of
quality health and mental health care, financial, legal, and
social supports, and child welfare reform.
In closing, no matter the circumstances, every child
deserves the roots and connection to the rich soil of family
that nourish their growth and prosperity. Grandfamilies provide
just that.
The Chairman. Thank you very much for your testimony, Ms.
Lent. I was struck by your line when you said that you can age
out of foster care, but that you cannot age out of a family.
That really sums up why this hearing is so important, so thank
you for being here.
Next we are going to hear from Dr. Dolbin-MacNab. Please
proceed.
STATEMENT OF MEGAN L. DOLBIN-MacNAB, PH.D., LMFT, ASSOCIATE
PROFESSOR, DEPARTMENT OF HUMAN DEVELOPMENT, DIRECTOR, MARRIAGE
AND FAMILY THERAPY DOCTORAL PROGRAM, FACULTY AFFILIATE, CENTER
FOR GERONTOLOGY, VIRGINIA TECH FACULTY OF HEALTH SCIENCES,
VIRGINIA TECH, BLACKSBURG, VIRGINIA
Dr. Dolbin-MacNab. Good afternoon, Chairman Collins,
Ranking Member Casey, and distinguished members of the
Committee. Thank you for the opportunity to testify before you
today on this very important issue. I am Dr. Megan Dolbin-
MacNab. I am an associate professor in the Department of Human
Development and director of the Marriage and Family Therapy
Doctoral Program at Virginia Tech. I have been researching
grandfamilies for approximately 20 years. Today, I will provide
testimony regarding the findings from scientific research on
grandfamilies. The testimony I provide today reflects my
professional views and experiences and not those of Virginia
Tech.
As Ms. Lent noted, in the United States, approximately 2.6
million grandparents are primarily responsible for the care of
their grandchildren. These grandparents play key roles in
ensuring the safety and stability of 2.5 million or three
percent of all U.S. children.
The majority of grandparents raising their grandchildren
are women, married, working, and younger than age 60. That
said, census data suggest that grandparents raising
grandchildren are disproportionately more likely to be divorced
or widowed, less educated, and living in poverty. They are also
disproportionately represented among racial and ethnic minority
groups, though rates are increasing among white, non-Hispanic
grandparents.
Grandparents assume responsibility for their grandchildren
in response to a variety of intersecting parental difficulties,
including abuse and neglect, incarceration, physical and mental
illness, and adolescent pregnancy. Of particular relevance to
today's hearing, parental substance abuse has long been noted
as one of the most common reasons that grandparents raise their
grandchildren. Beyond parental difficulties, however,
grandfamilies also develop in response to economic instability,
cultural traditions of grandparent involvement, and familism.
Raising a grandchild impacts all aspects of a grandparent's
life. According to the research literature, commonly reported
stressors include economic distress, legal difficulties,
inadequate housing, strained family relationships, and social
isolation. The demands of parenting may be particularly
stressful for grandparents because their grandchildren often
experience significant emotional, behavioral, and physical
difficulties. These difficulties have been associated with
grandchildren's histories of trauma and other adverse
circumstances.
Research has documented that the collective stressors
experienced by grandparents raising grandchildren can
negatively impact both their physical and mental health.
In terms of mental health, studies consistently demonstrate
that grandparents experience significant levels of depression,
at rates that are higher than those within the general
population.
With regard to physical health, early research suggested
that grandparents experience compromised physical health,
dissatisfaction with their health, and functional limitations.
More recent research, however, suggests that grandparents'
adverse health outcomes may have less to do with raising their
grandchildren, per se, and are more likely to be reflective of
risk factors such as poverty or preexisting health conditions.
Still, studies consistently find that grandparents raising
grandchildren experience a variety of serious chronic health
conditions and often engage in a variety of risky health
behaviors. This is particularly concerning given evidence that
grandparents often forgo preventative health care as a result
of putting their grandchildren's needs ahead of their own.
While the scientific research has illuminated the many
stressors and adverse outcomes experienced by grandparents
raising grandchildren, not all grandparents experience these
negative outcomes, and many are resilient in the face of
significant adversity. In fact, the experience of raising
grandchildren is not entirely negative. The emotional
connections that grandparents form with their grandchildren are
highly rewarding, as is the chance to provide their
grandchildren with better opportunities in life.
In light of this information, researchers are increasingly
examining grandparent resilience or the ability to positively
adapt in the face of adversity. Studies have found that
resilient grandparents have social support and demonstrate
optimism, active coping, resourcefulness, and a sense of
empowerment. Increasingly, researchers are developing and
testing promising interventions that promote grandparent
resilience and reduce adverse outcomes. Improving the quality
of the larger environments in which grandparents are embedded
is also important for promoting resilience.
Support services play a critical role in reducing adverse
outcomes and promoting resilience in grandparents raising
grandchildren. Unfortunately, research findings suggest that
grandparents underutilize these services due to ineligibility,
difficulty navigating multiple agencies, and an inability to
pay. Other barriers to accessing support include a lack of
awareness of available services and even negative interactions
with practitioners. Addressing these barriers requires a truly
ecological approach to intervention that attends to individual
level factors as well as macro level factors, including
increased availability of services and more flexible
eligibility guidelines.
Grandparents raising grandchildren are important resources
to their families and communities. Despite the challenges they
experience, grandparents are highly resilient and deeply
committed to giving their grandchildren the best lives
possible. Supporting them means supporting some of our Nation's
most vulnerable families.
Thank you for the opportunity to appear before you today. I
look forward to responding to your questions.
The Chairman. Thank you so much for your excellent
testimony.
Ms. Hoxie.
STATEMENT OF BETTE HOXIE, EXECUTIVE DIRECTOR, ADOPTIVE AND
FOSTER FAMILIES OF MAINE AND THE KINSHIP PROGRAM, ORONO, MAINE
Ms. Hoxie. Good afternoon, Chairman Collins, Ranking Member
Casey, and members of the Special Committee on Aging. My name
is Bette Hoxie, and I am honored to speak with you today
regarding both my professional and personal experiences with
this topic.
I am first and foremost a mother, grandmother, and great-
grandmother. I raised my grandson since his infancy, and he
will soon be 18 years old and graduating from high school and
on to study conservation law enforcement. I have to add, a few
months ago he originally said, ``I think I will do social
work,'' and I am thinking, ``Oh, please, no.'' But I did not
say that.
[Laughter.]
Ms. Hoxie. I just said, ``Do whatever you want,'' and
luckily he changed his mind.
I am also the executive director of Adoptive and Foster
Families of Maine and the Kinship Program. It is comparable to
what others were talking about with regard to the Navigator
Program, although we serve all three components, both foster,
adoptive, and kinship. The aspects of kinship care or
grandfamilies are closely replicated to the Navigator Program.
Like so many other states, as you have already heard, Maine
is severely affected by the opioid crisis that permeates our
Nation and its vulnerable families. More and more infants are
being born to mothers who are using opioids while pregnant.
These births are taking a toll on a population of caring people
who would, if they could, simply love their grandchildren,
spoil them, and send them home to be raised and nurtured by
their parents. However, obviously, for many families that is no
longer an option. Instead, the grandparents are becoming the
primary caretakers.
The organization that I work for, Adoptive and Foster
Families of Maine, works with an amazing team of professionals
throughout the state to support these grandparents, who, in
most cases, were never expecting to parent again, at least not
in this way. They may not have a spare bed at home or clothing.
They may need a crib. There are a number of different material
goods that they will not have access to. So one of the things
that our organization does on a very easy level is to collect
new and gently used items, including the beds and furniture and
clothing and make them accessible to the families. When we do
not have them immediately at one of our offices, we put it on
our list serve, and Maine's families are amazingly generous and
kind, and they frequently fill that void within a few days.
We also help the families as they are going through and
navigating the licensing process to become foster parents for
their grandchildren. And depending on where they are in time
and space, we may also be helping them to work through the
probate court system where some will get guardianship because
the Department of Health and Human Services is not involved.
For example, when they are going through the licensing
process, as Senator Collins indicated, this is sometimes a very
lengthy process, and it can be costly. Many of the homes in
Maine are older homes and the windows are not egress,
therefore, they will not pass the foster care licensing
standard and that can be a barrier. One of the things our
office has been able to do in some instances is to get
donations of windows that are the right size or get volunteers
who are willing to help install the windows, anything to try to
bring some of these totally unexpected costs down.
The organization provides specific support groups, and this
is huge for the families. Being able to talk with others who
are walking the walk and talking the talk just helps to make
you feel like you are more a part of things. It diminishes some
of the isolation that the other two presenters have talked
about. And also at those meetings, we have the children come as
well, so we provide child care, and that also helps them to
feel like, ``Wow, I am not the only one being raised by my
grandmother,'' or ``my grandfather,'' whatever the case is, and
they feel less isolated themselves.
Another benefit of those support groups is that although
many people think of respite care as something that should last
days or even weeks, for many of us--and I will include myself
in this number--15 minutes to spend in the bathroom or go to
the library to pick out a new book or even have time to read
that book is huge. So at these support group meetings, for an
hour and a half or two hours, they are engaging with other
adults and feeling like that is a form of respite, and the
children are in other rooms taking part in activities and
sharing their own experiences.
Something else that we are able to do is we rely on--you
know, it is not a one-stop shop. Adoptive and Foster Families
of Maine is a very small organization. Even though we have an
office in Orono and one in Saco, we only have a staff of seven
throughout the state, and two of them--three, actually, if I
count myself--are what we consider kinship specialists, but the
others have a variety of other designated positions. So we try
really hard to provide those families with training, and we do
a statewide training conference annually. And for the first 20
families, kinship or grandparents, who are unlicensed, we
provide them with the cost-free registration, and if they are
traveling more than 60 or 70 miles, we may also pay for their
overnight stay at the hotel because that is just so important
for them to have those opportunities to both learn and to
network.
I mentioned earlier that I raised my grandson. Well, today
I am raising a 19-month-old little boy. He is not biologically
related to me, but he is still part of my family. When I agreed
to raise my grandson nearly 18 years ago, I imagined, ``Will I
still be walking upright and be able to march with him as he
marches down the aisle?'' Just a few months away, I guess I
will succeed in that. But now I am looking at being past 70 and
at a little boy who is yet to be two years old, and my thinking
is: Am I the right person? I love him, he loves me. We love his
family. We are hoping for good things. But it is still a
question. And, you know, his mom is struggling with this
crisis, this world of the opioids, and, you know, I have no
idea. I cannot see into the future what that will be for her. I
know she loves her son, and that is huge. And I hope she loves
herself enough to get the help she needs.
But that is part of why I really want to talk with all of
you today, is to think about the ways that we can help this
whole dynamic. We cannot do anything in isolation. It cannot be
just the child. It cannot be just the parents. It cannot be
just the grandparents. It has to be an active networking to
provide supports to all concerned and not the least of which is
mental health care.
Funds to meet the barriers for these families can be huge.
Just traveling back and forth to the doctor with the children
is an unexpected cost, never mind things like child care, which
most of us need--clothing and diapers--all of these things are
added to families who had expected to be retired by now.
So I would just look to all of you because I think that it
is great that the families can rely on organizations like
Adoptive and Foster Families of Maine and individuals like all
of us here who care. But as a Nation, we also need to step
forward and say yes, you can rely on individual organizations,
but you can also rely on your country because you are doing
extraordinary work, keeping your family together as a family
and, moreover, keeping those children safe.
So I thank you for recognizing this important issue. I
appreciate the opportunity to share just a little bit of what
is happening in Maine, both in terms of what works--and there
are some things that work--and what continues to be
challenging. And I hope that I can respond to any questions and
be useful as you work to support grandparents raising
grandchildren who have been affected by the opioid crisis.
Thank you.
The Chairman. Thank you so much for your very compelling
testimony. You truly are one of those super heroes that we have
heard about.
And last but certainly not least, we will hear from Dr.
McDaniel. Thank you for being here.
STATEMENT OF SHARON McDANIEL, MPA, ED.D., PRESIDENT AND CHIEF
EXECUTIVE OFFICER, A SECOND CHANCE, INC., PITTSBURGH,
PENNSYLVANIA
Ms. McDaniel. Thank you. Chairman Collins, Ranking Member
Casey, and members of the Committee, good afternoon. I greet
you by saying ``Kasserian Ingera.'' ``Kasserian Ingera.'' ``How
are the children?'' The Masai Warriors of Africa go from
village to village asking, ``How are the children?'' And so
today you are asking, ``How are the grandfamilies and the
children?'' And I thank you.
I am Sharon McDaniel, President and CEO of A Second Chance,
Incorporated, a leader in kinship foster care and support
services in Pennsylvania. I am also on the Board of Trustees of
Casey Family Programs, the largest national foundation
dedicated to the safety, permanency, and well-being of children
in the foster care system.
Since 1994, A Second Chance has serviced over 21,000
children throughout the two largest counties--Philadelphia and
Allegheny County--in Pennsylvania.
Each day the dedicated staff of A Second Chance services
over 1,800 children. We have a mantra at A Second Chance that
says, ``Every child touched by A Second Chance has a right to
be safe and must thrive.'' We do not treat our children as if
they are in foster care but, rather, simply with family.
So who are the children? They range from newborns to 21
years old. Fifty-six percent of the children in our
Philadelphia office are under the age of five. This is an 11
percent increase in two years due to the opioid crisis. Forty-
eight percent of the children in our Pittsburgh office are
under the age of five. They are all enrolled in CHIP. They
receive Medicaid support. They are from urban and rural
communities and 82 percent of our kids have entered care
because of neglect which is often associated with parental
substance abuse.
Our caregivers, 65 percent of them are maternal
grandparents. Forty percent of all of our caregivers are
single, female heads of household. Sixty-seven percent are over
the age of 55, and they are often low-income. Our parents are
single moms (82 percent of them). They are low-income, and they
have a GED.
It is critically important to know that kinship families
are resilient and do not lose value in crisis. I am profoundly
humbled and appreciative to be able to share with you a couple
of stories where grandfamilies have stepped up and stepped in,
and I will start with my own. You see me.
From the time that I was two years old, I was placed in the
care of my fictive kin. They were not related by blood, but
related by the heart. They were members of my father's village.
Following the tragic death of my mother, my father sunk into a
deep depression and attempted to drink his way out of the
problem. And he realized that he did not want this life for his
young children.
I witnessed, and was central to, the personal sacrifices
that my grandparents had to make for us. And in the book that I
gave you all, I tell my entire story, so I hope you get a
chance to read it.
Today, I am reminded of a grandmother who I met a year ago.
She was 62 years old, and she had a successful career at
Verizon when she was suddenly asked to care for her five
grandchildren due to her daughter-in-law's opioid addiction.
The family made these arrangements outside of the child welfare
system. Unfortunately, due to the lack of supports, this
grandmother ended up losing her job, and she and her
grandchildren had to rely on TANF child-only payments to
support her financially. The provisions outlined in Families
First could have helped this grandmom. Thankfully, her faith
community stepped in. The grandmother said to me, ``Though I
may not have much, I have my grandchildren. They are with me
and not in the system, and we are going to be all right.''
Grandfamilies inside and outside of the child welfare
system need support. For those inside the system, they need to
be seen as an asset and not a problem. Grandfamilies already
deal with feelings of isolation and guilt, but they must be
treated with the dignity and respect that they deserve.
Grandfamilies outside the system need the same supports as
those offered inside--navigator programs, support groups,
financial support, and mental health counseling.
As a Nation, where would we be without grandfamilies? They
make unparalleled sacrifices because they value keeping their
families together.
In closing, my Grandma's Hands Support Group participants
told me to tell you this: ``We do what we do because we love
our grandchildren and our families. We need your help and
cannot do what we do without your love, support, and suspended
judgment of those we interact with each day. Treat us as if we
were your own grandchildren.''
Thank you for the opportunity to present to you today.
The Chairman. Thank you so much for your terrific
testimony.
Ms. Hoxie, I am going to start with you, not surprisingly.
You told me earlier when we were talking about your grandson
whom you raised from when he was just an infant, and he is now
18 and on the verge of graduating from high school, as you
shared with us. And he is a handsome young man, too, I might
add. You mentioned in your testimony that you are now
approaching 70----
Ms. Hoxie. I am past 70.
The Chairman. Or past 70, and I know from our previous
interactions that you have raised some 19 children over the
years. Now you are taking on the role of mother once again of a
toddler. Tell us what motivates you.
Ms. Hoxie. Well, I think it is what we have all talked
about. It is about keeping family together. He thinks of me as
his grandmother, and our family is his family. And so, you
know, I have a real passion for making sure that that family
stays as intact as it is possible. And I cannot see the--I do
not know what the future brings, but I know definitely that we
are his family.
The Chairman. Well, I think he is very lucky.
Ms. Hoxie. Well, when he is not wrecking my house, I think
I am pretty lucky, too.
[Laughter.]
The Chairman. You talked about the services that the
organization for which you work which helps not only kinship,
it provides programs for adoptive and foster and kinship
families, and you mentioned the importance of support groups
and respite care and how critical that is. Maine is a large
rural state where people often live in very small communities.
How do you cope with the barriers of providing services in a
state as large and rural as ours is?
Ms. Hoxie. For some things, you know, we have had a lot of
support between different staff at the Department of Health and
Human Services and other--you know, like where some of us from
the staff is constantly on the road, so we have learned to
rendezvous with folks who will say, ``Okay. We are going to be
at the Clinton exit in 20 minutes. Can we stop by and drop off
what you have requested?'' So sometimes it is as simple as
that.
With regard to support groups, we have 26 around the state,
and for a small state, that is a lot.
The Chairman. That is indeed.
Ms. Hoxie. But it still does not come close to meeting all
the needs, so we have developed a mentor program so people can
be on the phone and responding and helping them work through
whatever the issues are. Again, it is not 100 percent, but it
is a lot better than it could be.
The Chairman. And that must be particularly important when
you are dealing with children who have special needs.
Ms. Hoxie. Absolutely. And then, you know, a lot of my
staff have professional expertise in that topic, but we also
take advantage of a program called Maine Parent Federation,
which is another statewide organization that really provides
support to all families that may have a child with special
educational needs. And as you know, because so many of these
children have been prenatally exposed to drugs and alcohol, a
lot of them have a lot of issues educationally. Some would
happen perhaps just because of the climate, the atmosphere that
they were originally raised in. But many of them are prenatally
exposed, and their brains are really compromised,
unfortunately.
The Chairman. I really worry about those babies and what is
going to happen to them later on as the effect of that prenatal
exposure becomes evident, although I know we are doing a much
better job and have developed expertise in helping those little
children.
Ms. Hoxie. Exactly.
The Chairman. Ms. Lent, the Kinship Care Programs are a
great example of what can happen when agencies collaborate
effectively. When I considered the role of the Aging Network in
helping grandparents, I was surprised to learn that some states
are not expending the maximum allowable amount of their
National Family Caregiver Support Program funds. In fact--and
correct me if I am wrong--but I think you said only seven
states were using the program fully. Why do you think that is?
Ms. Lent. Sure. So the National Family Caregiver Support
Program allows ten percent of the dollars from that program to
be used to serve grandfamilies. The program is designed for all
types of family caregivers, but up to ten percent can be used
for these families. And what we find is that states need to
learn from each other about this issue and effective programs
to serve the families. So when the program was first enacted,
we put together some information to do some resource and
information sharing between states about effective uses of the
funds. It is not a lot of money, but we have seen some really
creative and effective use of these dollars from putting
together legal guides to operating support groups, to
information and referral services, to money for bunk beds when
there is an emergency.
So we really see a need to elevate those practices and
share information about effective use of these funds so that
the Area Agencies on Aging can understand the population
better--it is not a population that they are traditionally
thinking of serving--to educate them more on the special needs
of the population and creative and effective ways to serve
them.
The Chairman. Thank you.
Senator Casey?
Senator Casey. Thank you very much, Madam Chair, and I want
to, first of all, thank the panel for bringing your testimony
here and your experience, your expertise, and even your
passion. I will start with Dr. McDaniel.
We know that--we have some sense, I should say, not all of
us know for sure, but even someone who is not living through
this challenge knows the burden that folks are carrying. And
one of the issues is can that grandparent or grandparents, can
they access resources or information to help them, especially
initially when they know they have to take on a significant new
assignment? And I guess I would ask you, what can we do to be
helpful in providing more opportunities to create what I called
earlier a ``one-stop shop'' or one place for people to go? Is
that simply aggregating existing services or opportunities? Or
is that something where we have to create a new model or a new
paradigm?
Ms. McDaniel. Thank you, Senator, for the question. I think
Jaia talked earlier about how we can think differently about
places like senior centers in a different way. There are many
community resources, but it really is about the way in which
communities operate are currently in categorical places, so
senior funding does not cross over the child welfare funding.
So how do we create an integrated approach where, if a grandma
has a child that is inside the child welfare system or not,
that if she shows up at a senior center that she is able to get
all the supports that she needs for that young person. An
integrated model is what's needed in every community in
America. I think that would go a long way.
We need to also normalize. We talk about grandfamilies
living in isolation. Grandfamilies--and I am a grandmom--need
to know they are not alone in this fight, in this crisis. We
need to be able to think about public service announcements
where families live, work, and play; about having flyers and
information and letting them know that we are here with then.
Senator Casey. One issue that has arisen is access to
mental health services. Tell us about that, if you could, if
there are any barriers. What do you know about that?
Ms. McDaniel. The young people I serve are all eligible. In
fact, we enroll them in CHIP and Medicaid. But for
grandfamilies who are outside of the child welfare system, it
can be extremely difficult. They go to a TANF office. They are
asked a host of questions that they may not even understand or
know, and the process becomes very cumbersome.
We need to streamline the language and the process so that
when grandfamilies show up at these offices, they know what
they are being asked. I think if we do something like that will
help grandfamilies know that there are supports available.
There are kids who have had traumatic experiences. We need to
address their trauma because, otherwise, we are going to
continue to create another generation of young people who have
gone untreated.
Senator Casey. And I know that your work brings you in
contact with the health care system on a regular basis, and I
know that is not what you do most of your days making
recommendations about how to improve health care. But do you
have any suggestions that we should focus on, especially now
where we have the attention of the Nation on the question of
health care? Anything you would recommend there?
Ms. McDaniel. Children need health care. I just want to
share a story with you briefly. Two weeks ago, I had to work
with a family to bury a two-year old child. That child was
taken to the hospital, but did not receive appropriate
treatment, and the child died of pneumonia.
If she did not have health care, what would have happened?
She showed up with Medicaid. We need to make sure that families
have the health care that they need and also that our systems
are responsive to our children.
Senator Casey. I appreciate that. I will wait for the
second round.
The Chairman. Thank you.
Senator Cortez Masto, nice to see you.
Senator Cortez Masto. Thank you, Madam Chair, and thank you
for having this panel on this important topic.
I am the former Attorney General of Nevada and I bring that
up because I spent eight years addressing this specific issue.
I drafted legislation and worked to pass it through the
legislature to form a substance abuse working group that I
chaired. I additionally created a drug-endangered children's
unit in my office to address this issue. Moreover, I have been
very vocal about the opioid abuse occurring in the State of
Nevada and across the country that we see has just taken
control, unfortunately, of many of our lives.
And so I have a number of questions for you because I think
many of them are topics that we still need to address but we
are too afraid sometimes to bring forward. So let me just give
you an example.
In the State of Nevada, to get substance abuse treatment,
because there is very little of it, you have to commit a crime,
and you get priority for that.
Now, with that said, the Affordable Care Act has brought
additional resources for treatment--mental health treatment,
substance abuse treatment--and there is talk about repealing
it. I have concerns about how that is going to impact our
communities. Particularly, I am concerned about those who are,
unfortunately, going down the path of substance abuse and those
who must take care of their children.
I am curious. Does anybody have any thoughts on the impact
that taking away treatment, particularly for opioids, is going
to have across this country on the individuals who need it,
whether they are children or adults?
Ms. Lent. I am happy to speak to that. What I can say is
that health care is critically important to these families. In
particular, Sharon spoke to the fact that she works with many
families inside the system. We are also familiar with the needs
of families that are operating outside of the child welfare
system, so they have no one place to go for information and
support. However, when they do access some information about
what they can qualify for, usually the one thing that they can
access is Medicaid for the children, and that is critically
important.
And you also have families that may be too proud to access
any cash assistance or help, but they know that they cannot
afford the medical care for children, so they find that
critically important.
Actually, there was just a comment--Washington Post
commentator Michelle Singletary just did a story last week
talking about Big Mama, who she pulls a lot of her financial
advice from, and she specifically--she was raised by her
grandmother, Big Mama, and she said, ``Big Mama was too proud
to accept money, but she knew she did not make enough to get
treatment and medicine that we all needed.'' So she learned
from her. This is a person who is very savvy with dollars, but
she needed the medical support, and it was critical to her
family.
So Medicaid in particular is a critical foundation for
these families, and we would not want anything to tear away at
that critical program.
Senator Cortez Masto. And I appreciate that comment.
The other piece I see missing, and that we typically do not
fund, is education awareness. To me, that is the first step in
prevention, and it never gets funded. I had to fight for $1
million out of my legislature just to engage in an education
awareness piece on the threat of methamphetamine abuse, and
that was the only time that we had ever put money into
education awareness. I am concerned that we are still going
down that path with opioids, and, Dr. McDaniel, you talked
about it. It is about the education piece. It is about talking
about it. It is about making sure there are dollars going to
communities to teach them about what is happening with this
opioid crisis.
I am interested also, Dr. McDaniel, on your thoughts on
that, along with how we have an impact on our rural
communities. In Nevada, we have rural communities that are
challenged just to have resources or access to health care and
mental health needs. I am curious about your thoughts on how we
can work together to improve that at a federal level and
provide the assistance that is necessary.
Ms. McDaniel. Right. I would think about us going back to
funding the Kinship Navigator Programs. Those programs work in
rural and urban communities, so we have to make them available.
And the other piece that I wanted to go back to is the
education component. If we do not have the necessary treatment,
we will also see children languishing in foster care because
families will not be able to get the treatment to remediate the
issues. We already have over 400,000 children in the foster
care system. You will see that number go up if families do not
receive treatment because they cannot go back home, they cannot
be returned, if they have not addressed their drug and alcohol
addiction.
We need to make sure that the educational content addresses
treatment as well as what could happen in child welfare.
Senator Cortez Masto. Thank you. And I know my time is up.
I just want to say, though, about what you are doing with
respect to caregivers, that both the stress level and support
out there are crucial to our communities in helping address
this issue. And if there is a way that we can, Madam Chair,
figure out how we can provide additional support to the
caregivers as well, I am supportive of it, and I think it is
something we should be looking to do. Thank you.
The Chairman. Thank you very much.
Senator Donnelly?
Senator Donnelly. Thank you, Madam Chair.
Before I begin my questioning, I want to first share the
story of a woman from Indianapolis named Theresa Short. Theresa
is a grandmother who is currently raising her grandson because
her son suffers from an opioid addiction. She faces many of the
same challenges that have been highlighted in this hearing here
today.
When describing the difficulties of raising a grandchild
outside the formal foster system due to the opioid epidemic and
the challenges of accessing necessary resources for her
grandson, Theresa wrote, ``I could not get his medical records
because I had no legal guardianship. I had to buy him new
school supplies, new clothes and everything else a boy might
need. As a grandparent, I had to do this alone with no support.
The odds were stacked against my grandson and against me as a
grandparent. Without having legal guardianship of my grandson,
it made it difficult to reach out for help and to provide
services to our family. My grandson is hurting, and many times
he feels like he is already an adult. His childhood was taken.
The things he has gone through are not easy, and trying to
regain those relationships with his parents has been a process.
Our grandchildren need to have access to counseling, and
grandparents need to help change the cycle, and they need help
to do that.''
Theresa's story is shared by too many families in my home
State of Indiana and across our country. I want to thank all of
you for the work you do to address this issue and for taking
the time to testify here today.
Ms. Lent, I would like to ask you, as Theresa noted in her
story, many children impacted by the opioid epidemic need
access to counseling and mental health services. You mentioned
in your testimony that Medicaid plays a critical role in
providing health care to grandfamilies. In your view, how would
grandfamilies be affected and impacted by the attempt to cut
Medicaid spending by $880 billion in the American Health Care
Act?
Ms. Lent. Again, Medicaid is a critical source of support
for these families. To some families, it is the only federal
program or support that they do tap into, are aware of, and get
access to. So it is important for the children. Children that
are impacted by the opioid epidemic, if their parents are
struggling with addiction and they have trauma in their
history, they certainly need to get some support early on to
make sure that they do not fall prey to a similar path. And
having access to health care and stable support of a loving
caregiver are two critical factors in ensuring that they,
contribute and grow up to be healthy, thriving adults. And
Medicaid in so many of these families is a critical part of
that picture.
Senator Donnelly. Thank you.
Dr. McDaniel, you shared your organization immediately
seeks to enroll children in CHIP in order to assess their
medical needs. In your experience, are there sufficient
counseling services available to children? And how essential is
CHIP in connecting children to the counseling services that are
available?
Ms. McDaniel. Thank you for the questions, and let me
answer the first one. In terms of the services available for
children relative to trauma-informed care, absolutely no. There
are not enough providers to address their needs because it is a
specific way in which children need to be engaged when it is
trauma-informed. There are not enough providers in that space.
But in terms of CHIP, absolutely. Every child needs
Medicaid. They need to be enrolled, even in the interim of
finding that trauma-informed therapist or counselor. There
needs to be someone who can support that young person. So,
absolutely, CHIP is necessary.
Senator Donnelly. Thank you.
Thank you, Madam Chair.
The Chairman. Thank you, Senator.
Dr. Dolbin-MacNab, research findings suggest that being a
custodial grandparent is particularly taxing on those
grandparents who are raising children without the presence of
any parent. I was interested and heartened to learn from you
that some of the negative outcomes that you mentioned can be
avoided or turned around by those grandparents who are more
resilient. But my question to you is this: Is resilience an
innate quality that people have? Or is it something that can be
learned?
Dr. Dolbin-MacNab. Thank you for that question. Your
question underscores a significant point of discussion and
debate among those who study resilience. What we think is that
characteristics associated with resilience, including coping
skills, benefit finding, and seeing the good things in a
challenging situation--those are skills that can be trained and
developed. I have a colleague at Case Western Reserve
University, Dr. Carol Musil, who does wonderful work. Dr. Musil
and her colleagues provide resourcefulness training to
grandparents raising grandchildren, and this training has shown
very promising results related to reducing grandparents'
depression and stress, and improving their quality of life.
There may be people who are more resilient than others, but
many aspects of resilience are skills that can be taught. Also,
we can improve grandparents' resilience by improving the
quality of the environments in which grandparents are living.
Providing grandparents with some of the supports that we have
all been talking about today can help promote resilience as
well.
The Chairman. Thank you.
Dr. McDaniel, we have also talked about the financial
strain that many grandparents experience when they assume this
unexpected role later in life. As you mentioned, these
grandparents often spend their own money on housing and school
supplies and food--expenses that they had no reason to include
when they were doing their budgets for their older years.
How often do you see grandparents drawing on their
retirement savings or even returning back to work in order to
have sufficient funds to care for their grandchildren?
Ms. McDaniel. It happens every day for the 7.6 million
children that we talked about, caregivers are caring for those
young people outside of the child welfare system, and are doing
whatever it takes to make it. As you heard earlier, we know
that grandparents are often on limited incomes or poor. So what
are they tapping into if they are already poor? So we see them
going back into the workforce. We see them staying longer.
So I think one of the recommendations that I would make, we
need to do something in the industry in terms of looking at
employers. What are employers doing when it comes to
grandfamilies who are staying longer in the workforce? Are we
being sympathetic? Are we ensuring that child care is
available? The very same things we did when the Family and
Medical Leave Act first took place. We need to think about how
that is transferred and how that is translated to grandfamilies
who are working longer.
In the child welfare system, however, grandfamilies who go
through the process of foster care, they receive the same
dollars and support that a foster parent would receive. But,
again, those families outside of the system need that same
support.
The Chairman. You anticipated my next question which I was
going to ask Ms. Lent about. But, actually, I will ask all of
you just to go across, and that is, it seems to me we have an
unusual situation here. Obviously, it often is best for the
child to be with the grandparent or be with another family
member. And yet unless they go through the legal process, in
most states they are not going to get the financial assistance
they would receive if they were ``just foster parents.''
Now, I know many foster parents in Maine, and they do an
extraordinary job. They do get some assistance financially that
many of these grandfamilies do not get. So is that correct? Is
my understanding correct? And if so, do you have suggestions
for what we might be able to do? Ms. Lent.
Ms. Lent. Sure. So there is a continuum of arrangements
that we see with grandparents raising grandchildren. On the one
side, there would be those that go through the full licensing
process, get the windows up to the exact requirements, have the
right number of bedrooms, and go through that extensive
process. And when they go through that process, the vast
majority of those families would get the licensing rate that a
traditional foster parent would be. But that is a small portion
of all of the families.
There are also those that can be in unlicensed foster care,
so it is sort of an interim role where they may or may not get
some amount of money, but it is not going to be the same amount
as the fully licensed family.
And then on the other end of the spectrum, there are those
that just step in and keep the children from even making
contact with the child welfare system. And by stepping in, in
advance, and making sure that the child is safe and never even
needs to make contact with the child welfare system, in a sense
they are penalized, and they get almost no support. So that is
the challenge that we have.
Of course, we believe that we should be supporting families
with what they need, not based on what circumstances ultimately
brought the children into the relative's care. So we need to
find a way that we present them with their full range of
options, talk about the advantages and disadvantages of each,
and make sure they get the support that they need.
The Chairman. Thank you.
Dr. Dolbin-MacNab. One of the things that I have heard is
that many grandparents are afraid of the child welfare system.
They are afraid that their grandchildren will be taken away
from them. They are afraid that siblings will be separated.
Whether or not that is the case, that is a fear that they have,
and they often experience a sense of stigma related to being
involved in the child welfare system. Some of the grandparents
that I have worked with were involved with the child welfare
system when they were parents with their own children.
One of the things to consider is how can we raise awareness
among child welfare professionals and educate grandparents so
that these systems can better support grandparents and so that
these systems are not perceived by grandparents as being an
adversarial environment and experience.
The Chairman. Ms. Hoxie?
Ms. Hoxie. Well, I would like to share just a quick story.
I have been working with a grandmother who has a very medically
fragile baby that was placed with her because of her daughter's
use of opioids, and she travels 240 miles twice a week to get
the baby medical treatment, and at least once from Maine,
Downeast Maine, to Boston once every 4 to 6 weeks.
When she took the baby, it was with the fact that it was a
safety plan. The Department of Health and Human Services had
intervened, but they opted not to take the child into custody
and left her with her grandmother. The grandmother was working.
She had a reasonably good job. But because of the baby's
incredible medical needs, she took family leave in the
beginning. She went on to take leave without pay. During that
time she really fell behind, and she was in danger of losing
her vehicle.
Now, imagine what it would be like to know that is the only
way that you can get access to medical treatment for that
child, and there she was about to lose it. We were able to get
some help for her and get her payments caught up, and she has
since gone back to work, and she is in the foster care
licensing process now, and the Department has taken custody.
So, eventually, until she is licensed, she will get $10 a day.
But in the meantime, there is this huge gap. And, interestingly
enough--and part of this is--what I am getting to is that part
of it is creating that awareness throughout the state and
within the systems, including the Department of Health and
Human Services, of how important it is, if you are going to
take custody, to do it quickly so that the family has just even
that minimal support.
In Maine--and I do not know if it is across the country,
but in Maine, for babies that are medically fragile, that could
actually succumb to these effects of that fragility, they
actually--once they are licensed, they are eligible for $60 a
day. But here 10 months have gone by without them getting
anything just because of gaps in the system and people not
being aware.
So when we are educating people, we just need to do a
better job of emphasizing the possibilities and to encourage
that those safety plans, if you will, do not go longer than the
designated 35 days, or whatever it is in whatever state,
because that will make a huge difference for some families. I
mean, obviously, there are many other issues, but that one
comes to mind quickly because, you know, I felt so badly for
this family.
The Chairman. Thank you.
Dr. McDaniel--I know I am way over my time--did you have
anything you wanted to add?
Ms. McDaniel. I just offer that if we would consider
federal child welfare finance reform, that initiative would
allow us to look at how we fund child welfare. In the current
system, the child has to be abused or neglected in order to
receive resources. That should not happen.
The Chairman. Thank you.
Senator Casey?
Senator Casey. Thank you very much.
Ms. Lent, I wanted to go back to your written testimony.
Despite all the challenges that we have outlined or articulated
here today, it is remarkable when you put on paper that list of
positive outcomes that come from relative care, where you say
on page 4 of your testimony, ``reinforces safety, stability and
well-being, reduces trauma, reinforces child's sense of
identity, helps keep brothers and sisters together, honors
family and cultural ties, and increases the likelihood of
having a permanent home.'' Really powerful outcomes for that
child and that family.
I guess that leads me to one question. You made reference
to a foster care savings of about $4 billion. Can you tell us
about that?
Ms. Lent. Sure. We know that the vast majority of children
being raised by grandparents are being raised outside of the
foster care system, so I talked about those on this end of the
continuum that step in and keep children out of foster care, so
never entering the foster care system.
Well, when you look at the savings from that foster care
payment, it is conservatively $4.5 billion a year per year. So
there are savings that come from that.
But there are also long-term savings, I would also suggest,
because the children fare so well, so much better in the care
of relatives, the children have fewer behavioral and mental
health issues in the long run, so they are more likely to end
up being contributing to our communities and our economy in
positive ways.
Senator Casey. I appreciate that, and it is important for
us to know that number.
Dr. McDaniel, you had shared in your testimony the story of
the grandmother who--let me get your exact words. You said that
she was a 62-year-old grandmother who ``had a successful career
at Verizon when she was suddenly asked to care for her five
grandchildren due to her daughter-in-law's opioid addiction.''
You go on to say that she had real trouble and her faith
community saved her.
Ms. McDaniel. Yes.
Senator Casey. Tell me about that example and the reason
you raise that example in your testimony. What is the point
that we should take away from that?
Ms. McDaniel. Right. I raise that because she was quite
isolated. She did not know about the community resources that
were available. She had gone to the child welfare system, and
they told her, ``Well, because your family made those
arrangements first, you are not eligible for any support from
us.''
So she went to the TANF office, and they said, ``We are
going to give you TANF and Medicaid and pretty much that is
about it''. If she was trying to get child care, she could not
get child care, so she ended up losing her job. And what I did
not add was that she was living in a one-bedroom apartment. If
she was in the child welfare system, they would have said that
was not adequate--``We need to move you to a larger place.''
But she should not have had to go to a child welfare office to
get that support for the children that come in care.
So Navigator Programs, support programs, programs that are
associated with senior centers are the kinds of resources she
should have been able to go and get the support that she
needed, not lose her job. She was almost retirement age, but
she had to give up all those years because she did not have the
adequate supports.
Senator Casey. I appreciate that. Thank you.
Ms. McDaniel. You are welcome.
The Chairman. Senator Warren.
Senator Warren. Thank you, Madam Chair, and thank you very
much for holding this hearing, and thank you, Ranking Member.
Last week, I was at the Manet Community Health Center in
Quincy, Massachusetts, and the week before that, I was at Lynn
Community Health in Lynn, Massachusetts, and talking to
physicians and first responders and patients and local
officials about how this public health care crisis has
devastated communities and families across our Commonwealth.
According to the Massachusetts Department of Public Health,
an estimated 2,000 people in our state died for opiate
overdoses just last year. And as the Chair and the Ranking
Member have noted, thousands of children are affected, and many
are left in the care of their grandparents. And I have seen the
data on this that children whose parents struggle with
substance abuse disorder are about twice as likely to develop
the disorder themselves.
So where I wanted to start this was a variation on the
question that Senator Casey just asked Dr. McDaniel, and that
is about resources and connections. But this one is about when
you suspect a substance abuse problem.
Ms. Lent, can I ask you, if grandparents become concerned
about a grandchild's substance use, are there good options for
them to access treatment or counseling in their own
communities, maybe through a pediatrician, that grandparents
are readily familiar with?
Ms. Lent. So, again, those that are already connected to
the child welfare system would probably turn to the social
worker at the child welfare system for that information. But
the vast majority do not have that resource available to them,
so best-case scenario they live in a community that has a
kinship navigator, where they would have a one-stop-shop answer
to those questions. But those are also not available in most
communities right now. We would like to see them.
So I would say the vast majority of families in that case
are going to look to the physician that they are connected
with, probably their child's pediatrician, so it would be very
important that the physician is familiar with issues of
substance use and how it affects children when they are exposed
and when their families are dealing with that crisis and to
coordinate those services.
Those that may not even be comfortable talking to their
physician are going to look to their peer network, and that is
why support groups and other types of services of some of the
agencies represented here are really important because that
peer-to-peer communication and where to go for support is
really critical as well.
Senator Warren. I understand that, and I think that is
really important.
Did you want to add to that?
Dr. Dolbin-MacNab. Yes, thank you. Related to your
question, there are some really exciting intervention models.
One of those approaches is nicknamed SBIRT, which refers to
Screening, Brief Intervention, and Referral to Treatment. This
approach involves training a variety of practitioners, everyone
from nurses to physicians, to screen people where they are and
to make referrals in their communities for substance abuse
treatment. I am in a rural community, and I think those types
of resources are so important because people will go to their
doctor to talk about what is going on, but they may not
necessarily access a substance abuse treatment facility.
Senator Warren. Right. And, you know, your point gives me a
chance to talk about one in Boston, but it is the reminder, how
many different kinds of services may be needed when it is time
to intervene. The adolescent substance abuse program at Boston
Children's Hospital brings together whole teams of
pediatricians, social workers, child psychiatrists. They work
on screening, they work on diagnosis, and they work on
treatment for adolescents who have substance abuse disorder.
And the idea is to do this hopefully at a time when they can
keep children both at home and in school and try to work
through these problems. And the program partners with pediatric
practices throughout the region so that local doctors can get
engaged in this.
I take it from your comments, and from everyone nodding
their heads about this, that this is an important thing for us
to expand, that this is the kind of thing that we should try to
make available throughout the country, so someone has got to
weigh into this.
I want to ask another part about this, and that is, when
grandparents are trying to get substance use disorder diagnoses
and treatment, both for their children and for their
grandchildren, or for either, how important is health care
coverage to providing access to preventive screening and to
specialty care? Ms. Lent, could I ask you about that?
Ms. Lent. Again, I would say it is critically important. I
conveyed earlier that often when they do not have access to
other services, they still have access to Medicaid for the
children, and so that is a critical resource to them, again.
But they need to be aware of it, so things like Kinship
Navigator Programs and resources that can connect them to those
services are important. But the health care is foundational.
Senator Warren. Right. And if the cost of health care goes
up or if Medicaid is sharply cut, what will be the impact? Ms.
Hoxie, maybe would you like to speak to that?
Ms. Hoxie. Well, I can certainly speak on a personal note.
Senator Warren. Yes.
Ms. Hoxie. If I did not have medical coverage for my
children, I cannot even imagine, you know, what it would be
like, and certainly for the families that I work with.
I can give you one example of a family that lived in a
rural area in Maine, and the grandmother was caring for her son
who was addicted--his child--I do not know where the mother was
in all of this--and her husband was ill. The son eventually
overdosed and died, leaving grandmother with, ``Oh, my gosh,''
you know, ``how do I meet the needs, the mental health needs
now of this grieving child?''
Two weeks later, her husband passed away, so she was, you
know, looking everywhere to find grief counseling, and in the
area that she lived in, there was not anything that was going
to be available for 16 weeks.
So I do not know if that answers your question, but going
without it, you know, was devastating. And they did eventually
find somebody that would work with them individually. She
wanted someone that would work with them as a grieving family
and with a child with some significant mental illness himself
at this point.
Senator Warren. I appreciate that, and I see you all
nodding on this. You know, the Affordable Care Act made it
possible for many families that are struggling with substance
abuse to get access to the care that they need. And if the
mental health and substance abuse disorder protections of the
ACA are cut out, the estimate is that there would be $5 billion
in resources taken out of this area, which would make it a lot
harder for families to get their lives back on track.
So this is something that I appreciate your talking about
and a reminder of how much we need to do to make sure that we
are trying to support families that are struggling with this
terrible epidemic. Thank you.
Thank you, Madam Chair.
The Chairman. Thank you.
I want to thank all of our witnesses for testifying today.
Your testimony was so compelling and educational, not only to
the members of this panel, but to those who are watching on C-
SPAN and to others who will learn about this hearing.
One of the motivations for holding this hearing was to
raise public awareness about the growing prevalence of
grandparents raising grandchildren, something that has always
occurred in society, as Dr. McDaniel has made clear, but we are
seeing a huge increase as a result of the terrible opioid
epidemic that is devastating so many families in so many
communities across our country.
Through your programs, your advocacy, your research, your
service, and your testimony today, you are truly making a
difference, and I thank each and every one of you for that.
I thought that I would conclude my comments, before turning
to my colleague, by quoting on the plus side of what happens
when a grandparent takes in a grandchild, and this was from an
interview of a grandmother who was interviewed on Maine
television recently. She put it best when she said, ``When your
grandchild looks at you and says, `I love you more than 500
peanut butter sandwiches,' then you think to yourself, in the
end it is worth it to know they are happy and safe. You know,
just normal little boys. Maybe a little overactive, but a
normal little boy.'' And that really does sum it up, and that
is the benefit of kinship care.
Federal policies such as the National Family Caregiver
Support Program continue to serve as a critical resource, but I
agree with Ms. Lent in that a lot of states do not think of
that program as a way to help grandparents that are raising
grandchildren. There, again, I hope that we are raising the
awareness of area Agencies on Aging, which do such fabulous
work, that this is another possible use of the funding. We are
going to continue to work together to look at what else we can
do.
In the meantime, I think we have an enormous debt of
gratitude to those grandparents who are opening their homes and
their hearts to their children's children.
Senator Casey?
Senator Casey. Madam Chair, thank you, and thank you for
having this hearing and convening us. We hope we do not have to
have future hearings on this topic, but I am afraid we may.
I did want to reiterate what many of us have been thinking
and I think some of us have tried to articulate one way or the
other, and that is the heroic nature of what these individuals,
these families are doing. We live in a society which, for not
just recently but over, unfortunately, many generations, the
people that we tend to point to as heroes really are not
heroes. They are movie stars, athletes or people like that--
really are not heroic. Soldiers are heroes, of course. People
who protect us every day are heroes. And people who provide
this kind of care and security for their family and in a sense
our extended family are really heroic.
To use an old expression, they lead quietly triumphant
lives. Their names are not in the paper. They are not the
subject of a claim of notoriety, but they get up every day and
take on a more difficult task of raising children when they
were looking forward to a tranquil and restful retirement.
I do believe that we can come together and do more. I do
not think the Federal Government is always the place to turn to
for a new program or a new strategy to deal with the problem.
But there has to be a way that the Federal Government can be a
constructive partner in helping states and communities to
aggregate services to come together. And we had some examples
of that and some recommendations today.
I think we have to make the right decisions the next couple
of weeks and months on a range of policy matters, especially
those relating to ACA and Medicaid especially, and I will be
talking more about that. But we are grateful that you brought
your own stories, your own expertise, and your own passion
about these issues before us today.
As a Pennsylvanian, I am especially grateful to Dr.
McDaniel here, and also, Ann and Marvin, we are grateful that
you made the trip to be with us today.
But to all of our witnesses, I thank you for doing this,
and thanks for bringing this information and heightening
awareness of this challenge.
The Chairman. Thank you, Senator Casey.
Committee members will have until Friday, March 31st, to
submit questions for the record. If we receive some, we will
forward them on to you. Again, my thank you to all of you for
your participation today.
This hearing is now adjourned.
[Whereupon, at 4:07 p.m., the Committee was adjourned.]
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APPENDIX
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Prepared Witness Statements and Questions
for the Record
=======================================================================
Prepared Statement of Jaia Peterson Lent, Deputy Executive Director,
Generations United, Washington, DC
Generations United is pleased to provide testimony to the Senate
Special Committee on Aging. We applaud Chairwoman Collins, Ranking
Member Casey, and members of the committee for your leadership in
holding this hearing on the important role of grandparents and other
relatives in providing safe and stable homes to children who cannot
remain in the care of their parents, and the sharp increase in this
trend attributed to the opioid crisis.
Today's grandparents provide a continuum of care from part- or
full-time child care to raising a grandchild due to the parent's death,
disability, addiction or military deployment. This testimony will focus
on grandparents and other relatives raising children, also known as
grandfamilies.
According to the U.S. Census, more than 2.6 million grandparents
report they are responsible for their grandchildren.\1\ About 7.8
million children live in households headed by kin--a grandparent,
uncle, aunt or other relatives.\2\ About 2.5 million children are
living with grandparents, relatives or close family friends without
either of their parents in the home.\3\
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\1\ U.S. Census Bureau, 2015 American Community Survey.
\2\ U.S. Census Bureau, 2010 Census.
\3\ Annie E. Casey Foundation Kids Count Data Center. 2013-2015
Current Population Survey Annual Social and Economic Supplement.
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There are many kinds of grandfamilies. In some grandparents are
raising children inside the formal foster care system as licensed or
unlicensed kinship foster parents. Some have legal custody but no
connection or support from the child welfare system. Still others are
raising the children informally without legal custody or guardianship.
While the challenges these families face are varied and complex, they
are united by one common factor: they believe beyond a shadow of a
doubt in the importance of family. They believe children fare better
when they are raised in a family, not a system, and they are right. Yet
we cannot ignore the fact that they often step in at great personal
sacrifice, impacting their own health, family relationships, retirement
plans and financial well-being. These caregivers, and the children they
are protecting and nurturing, deserve our respect and support.
My testimony today will focus on four key points:
One, the impact of the opioid epidemic on grandparents
and other relatives;
Two, the critical role of grandparents and other relative
caregivers in helping children thrive when their parents are no longer
able to care for them;
Three, the importance of supportive services to help
grandfamilies succeed; and
Four, the valuable role that the National Family
Caregiver Support Program and Area Agencies on Aging can play in
helping respond to the crisis.
First, a little about Generations United. Generations United is the
only national membership organization focused solely on improving the
lives of children, youth and older people through intergenerational
strategies, programs and public policies. Since 1986, Generations
United has been the catalyst for policies and practices stimulating
cooperation and collaboration among generations. We believe that we can
only be successful in the face of our complex future if generational
diversity is regarded as a national asset and fully leveraged. For
almost twenty years, Generations United's National Center on
Grandfamilies has been a leading voice for issues affecting families
headed by grandparents or other relatives and the need for evidence-
based practices to support them.
Impact of the Opioid Epidemic on Grandparents and Other Relatives
Who are the grandparent caregivers? They are diverse in terms of
race, culture, income and geography. Thirty-nine percent are over the
age of 60 and approximately 58 percent are currently in the workforce.
They are more likely to live below the poverty line than their peers--
21 percent--and 26 percent have a disability. They face unique
challenges that impact their well-being and their ability to fully
support and parent their grandchildren.
Unlike parents or foster parents who plan for months or years to
care for a child, these grandparents or other relatives usually step
into their role unexpectedly. Some may have received a call in the
middle of the night telling them to come and pick up their
grandchildren or they will end up in foster care. Suddenly, they are
forced to navigate complex systems to help meet the physical and
cognitive health challenges of the children who come into their care,
often after experiencing significant trauma.
Caregivers may struggle with their own mental health issues
stemming from feelings of shame, loss or guilt about their adult
child's inability to parent. They may suffer from social isolation and
depression because they do not want their peers to know about their
situation or because their peers are no longer parenting. Caregivers of
children whose parents are using drugs may have their stress
exacerbated by trying to maintain or navigate an ongoing relationship
between the child and parent, often unaware if the parents are
currently using drugs or alcohol and how their behavior will impact the
child. Relative caregivers are often grieving a host of losses,
including that of the treasured traditional grandparent role, control
over their future, financial security or even the ability to go on
vacation.
Taking on the unexpected expense of a child can be especially
devastating to caregivers living on fixed incomes. Countless
grandfamilies report spending down their retirement savings to address
the health, mental health, food and clothing needs of the children, or
to pay legal expenses from seeking legal custody of the children.
Others turn their retirement savings into college tuition payments.
Many older caregivers live in one bedroom apartments or senior housing
where children are not welcomed and need to move to larger, more
expensive housing.
While grandparents have been called upon to raise children for many
reasons over the years, the current opioid and heroin epidemic is
overwhelming many families and child welfare systems.
Grandparent Pamela Livengood shined a light on impact when she
said, ``For my 50th birthday, I got a two-year-old. My story isn't
unique. The [opioid] epidemic has devastated communities all over the
country. It doesn't discriminate against age, race or gender. It
affects all of us.''
After years of decline, the overall numbers of children in foster
care are on the rise. From state to state, experts say the current
opioid and heroin epidemic is the number one reason for this
increase.\4\ Recent data show the percentage of children entering
foster care due to parental drug and alcohol use rose from 22 percent
to nearly 30 percent in just five years.\5\ This was the largest
increase in any reason for removal. Some pockets of the country report
as high as a 33 percent increase in the numbers of children in state
custody.\6\
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\4\ Examining the Opioid Epidemic: Challenges and Opportunities:
Hearing before the Committee on Finance, Senate, 114th Cong. (2016)
(statement of Nancy Young, Ph.D., Director, Children and Family
Futures, Inc., Lake Forest, CA). | Kamp, J. & Campo-Flores, A. (2016,
January 11). Parents' drug abuse strains child-welfare agencies:
Growing epidemic puts more children into foster care.
\5\ National Data Archive on Child Abuse and Neglect. (2009-2015).
Adoption and Foster Care Analysis and Reporting System, Foster Care
Files 2008-2014. Retrieved from http://www.ndacan.cornell.edu/datasets/
datasets-list-afcars.cfm.
\6\ Quinton, S. (2015, October 9). How heroin is hitting the foster
care system. Pew Charitable Trusts, Stateline. Retrieved from http://
www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/10/09/
how-heroin-is-hitting-the-foster-care-system.
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The current epidemic is hurting our country's families and
stressing many state's child welfare systems. Child welfare systems are
increasingly looking to grandparents and other relatives to care for
the children as they face shortages of foster parents to meet the
growing need. In 2014, more than a third of all children who were
removed from their homes because of parental alcohol and drug use were
placed with relatives.\7\
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\7\ Analysis conducted by Children and Family Futures (CFF) on the
public use 2014 Adoption and Foster Care Analysis and Reporting System
dataset. Estimates based on all children in out of home care at some
point during Fiscal Year 2014.
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This is not just a child welfare system issue. As one grandmother
said, ``Grandparents are doing whatever it takes to bring their
grandchildren to safety.''
Although the child welfare system relies heavily on relatives, the
number of grandparents, uncles, aunts and others who step in to care
for children and keep them out of foster care far exceeds those raising
children inside the system. In fact, for every child being raised in
foster care (often referred to as ``formal care'') with a relative,
there are 20 children living with grandparents or other relatives
outside of the foster care system, in ``informal care.'' Often thrown
into this caregiving role with little or no warning, caregivers
frequently do not know about supports and services for which they may
be eligible. Those raising children outside the system usually struggle
with even less support. They save our country's taxpayers more than $4
billion a year by raising and keeping children out of foster care.
These families deserve our respect and support.
Impact of Grandparent and Other Relative Caregiving on Child Well-being
Grandparents and other relative caregivers play a critical role in
helping children thrive when their parents are no longer able to care
for them.
Despite the challenges facing grandparents and other relatives
raising children, children fare well in the care of relatives. Compared
to children in non-relative care, they have more stability, are less
likely to run away and are more likely to report feeling loved. When
children cannot remain with their parents, research shows placing
children with grandparents or other relatives:
Reinforces safety, stability and well-being
Reduces trauma
Reinforces child's sense of identity
Helps keep brothers and sisters together
Honors family and cultural ties
Increases the likelihood of having a permanent home \8\
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\8\ Generations United. (2016). Children thrive in grandfamilies.
When explaining why it was so important that he had been raised by
his grandparents, Ray Krise, a member of the Skokomish Tribe near
Shelton, Washington, said, ``If not for being raised by my
grandparents, I would not have a cultural identity. I wouldn't know my
family lineage and my son would not bear the name Tcha-LQad--a name
that is 17 generations old . . . [They] helped me develop a real sense
of pride and belonging.''
Grandfamilies are also more likely to continue to provide a safe
haven for a child long after they have turned 18 or transitioned out of
the foster care system. A young person may age out of a system--they
never age out of a family.
Importance of Supportive Services to Help Grandfamilies Succeed
While many strengths, challenges and needs are shared by these
diverse families, the level, length and type of supports they need
vary. Unfortunately, the degree to which these families receive
supports and services from the child welfare system is often tied
largely to the way in which they happen to come into their grandparent,
aunt, uncle, or other relative's care, not the needs of the family.
Grandparents who are able to step in to protect and care for their
grandchildren and keep them out of the child welfare system are, in a
sense, punished for this critical and loving act. While services are
often still inadequate for caregivers who become licensed as foster
parents, they are far more likely to receive crucial supports and
benefits than those raising children outside foster care. Child welfare
programs should do more to prioritize supports for caregivers who keep
children out of foster care and address barriers to licensing relatives
as foster parents when it is the best option for the family. Networks
of aging services agencies and other community supports can play a
critical role in helping these families by coordinating with child
welfare agencies to provide seamless supportive services to families
with older caregivers of children who are not getting the full range of
supports and services they need from the child welfare system.
Families commonly face challenges that can be addressed through the
provision of key supports and services such as:
Information and Referral Services such as kinship navigator
programs that provide a single point of entry for learning about
housing, household resources, physical and mental health services and
financial and legal assistance.
Physical and Mental Health Care and Services for older caregivers
and children including Medicaid and Medicare, which have proven to be
critical resources to grandfamilies. Quality counseling and trauma-
informed mental health services have been shown to improve outcomes for
the caregivers and children.
Affordable Legal Services so grandfamilies impacted by parental
substance use disorders, whether inside or outside the foster care
system, can access a continuum of legal relationship options and
understand the differences--both legal and practical--of adoption,
guardianship and legal custody.
Lifespan Respite provides coordinated, community-based respite for
family caregivers caring for individuals with special needs of all
ages.
Financial Supports including access to Temporary Assistance for
Needy Families (TANF)--one of the three primary purposes of which is to
support children in the care of relatives, Social Security retirement,
disability and survivor benefits for both the caregivers and for the
children, and Supplemental Security Income for low-income caregivers
and children who are disabled.
Valuable Role That the National Family Caregiver Support Program and
Area Agencies on Aging Can Play in Helping Respond to the
Crisis
When the National Family Caregiver Support Program (NFCSP) was
signed into law as part of the Older Americans Act in 2000, Generations
United successfully advocated that grandparents and other relatives
raising children be included to support older Americans not only as
those receiving care but also as those giving care. Current law gives
states the option to use up to 10 percent of state NFCSP dollars to
serve grandfamilies in which the caregiver is age 55 or older.
According to the Administration for Community Living's Aging Integrated
Database (AGID), only seven states use nearly the full 10 percent of
funds to serve the families.
Those who do use the funds to serve grandfamilies report
significant impact. But they are stretching scarce resources elevating
the urgency for additional investments to adequately meet the needs of
grandfamilies. Examples of successful uses of funds range from
information and referral services to support groups to legal guides and
clinics. Families benefiting from services through the aging network
report positive experiences and outcomes. They are often more receptive
to services provided through the aging network, because they have a
higher level of comfort with those agencies than the child welfare
system, which many may fear or distrust.
Policy Recommendations
Protect the Social Services Block Grant (SSBG): SSBG
provides critical support to states to serve children and older adults
in communities, many of whom are in grandfamilies, through a range of
community-based supportive services such as home-based meals, child
care and child protective services. This flexible resource allows
states to use the funds to meet local needs where they are greatest.
Ensure Access to Quality Health and Medical Care: Ensure
that health care reform efforts recognize the critical role that
Medicaid plays in providing health care coverage to grandfamilies.
Health care reform efforts should not prevent the children and
caregivers in grandfamilies from having access to quality health and
mental health care, or the ability of parents to access substance abuse
treatment and prevention services.
Promote Services to Grandfamilies Through the Network of
Organizations Serving Older Americans: Urge states to maximize use of
the National Family Caregiver Support Program (NFCSP) to serve
grandfamilies. NFCSP funds may be used to provide supportive services
to caregivers and children in grandfamilies regardless of whether they
are involved with the child welfare system or have legal custody of the
child. Although up to 10 percent of the program's funds can be used for
grandfamilies, most states do not make full use of the program to help
support these families. Policy should support national experts and
other resources to help educate the aging network about grandfamilies
and the most effective services to support them.
Address Barriers to Licensing Grandparents and Other
Relatives as Foster Parents: Adopt the Model Family Foster Home
Licensing Standards, which Generations United developed in partnership
with the National Association for Regulatory Administration and the
American Bar Association Center on Children and the Law and with
support from the Annie E. Casey Foundation, to eliminate unnecessary
barriers that prevent suitable relatives and non-relatives from
becoming licensed foster parents.
Reform Federal Child Welfare Financing to Encourage a
Continuum of Tailored Services and Supports for Children, Parents and
Caregivers in Grandfamilies: Allow states to use federal child welfare
funds for prevention services for caregivers, parents and children,
such as kinship navigator programs, substance abuse treatment and
prevention services, mental health services and in-home supports.
Encourage Coordination of Services and Supports Among
Temporary Assistance for Needy Families (TANF), Child Welfare and Aging
Services Agencies: Through coordination, leveraging and braiding
dollars among these agencies, more children and caregivers can be
served.
Ensure Grandfamilies Can Access Financial Resources to
Help Them Meet the Children's Needs Such as TANF, Social Security, and
Tax Relief: Access to TANF must be improved through a number of
concrete policy and program steps including eliminating asset tests for
caregivers over age 60 so that they can have savings for retirement;
Social Security retirement, disability and survivor benefits and
Supplemental Security Income must be protected and strengthened; and
tax reform efforts should preserve the ability of grandfamilies to
qualify for the Earned Income Tax Credit.
Provide an Array of Legal Options to Grandfamilies:
Ensure that grandfamilies have access to a continuum of legal
relationship options and understand the differences--both legal and
practical--of adoption, guardianship and legal custody. As part of this
effort, grandfamilies' access to legal representation and assistance
should be improved and expanded. Furthermore, all states should enact
educational and health care consent laws so that children outside the
foster care system and without a legal relationship to their caregivers
can access education and health care services.
Elevate and Promote Best Practices Through a National
Technical Assistance Center on Grandfamilies: Create a National
Technical Assistance Center on Grandfamilies that engages experienced
experts to provide a clearinghouse of best or promising practices and
programs for serving children, parents and caregivers in grandfamilies.
This includes guidelines for states to encourage best practices to
support grandfamilies impacted by parental substance use, including
ways to help caregivers meet the children's needs and support birth
parents' access, engagement and success in treatment. The Center can
facilitate learning across states and provide technical assistance and
resources to those who directly work with all three generations in
grandfamilies.
Conclusion
Stacey Walker, who along with his sister was raised by his
grandmother, said, ``My grandmother already lived in a government
housing project, and although her salary was enough to keep her afloat,
she now had all sorts of expenses . . . any young child's needs,
multiplied by two.'' Stacey's grandmother sacrificed, scrounged and
succeeded in raising her grandchildren. Stacey is what we at
Generations United call a ``grand success.'' This past November, Stacey
was elected the first African American supervisor of the Linn County
Iowa Board of Supervisors. After his election, Stacey said, ``It's an
honor to be an example of the value of being raised in an
intergenerational home!''
No matter the circumstances, every child deserves the roots and
connection to the rich soil of family that nourish their growth and
prosperity.
Thank you for this opportunity to speak.
__________
Jaia Peterson Lent
Response to Questions for the Record
Sentor Elizabeth Warren
Opioid Epidemic and Partial Fill Policies
Older patients are frequently prescribed painkillers for chronic
pain, or after surgery or other procedures.\1\ The Center for Medicare
and Medicaid Services (CMS) reported that generic Vicodin was
prescribed to more Medicare beneficiaries than any other drug in
2013.\2\ In 2015, almost 30 percent of Medicare Part D enrollees used
an opioid prescription.\3\ If older adults don't use their entire
prescription, these pills can remain in the home--and the National
Institute on Drug Abuse has estimated that over 70 percent of adults
who misuse prescription opioids get the medication from friends or
relative.\4\
---------------------------------------------------------------------------
\1\ Ibid.
\2\ Centers for Medicare & Medicaid Services, ``CMS Releases
Prescriber-Level Medicare Data for First Time'' (April 30, 2016)
(online at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-
sheets/2015-Fact-sheets-items/2015-04-30.html).
\3\ Paula Span, ``New Opioid Limits Challenge the Most Pain-
Prone,'' New York Times (June 6, 2016) (online at: https://
www.nytimes.com/2016/06/07/health/opioid-limits-older-patients-
pain.html).
\4\ National Institute on Drug Abuse fact sheet (online at: https:/
/www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf).
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As a consequence, efforts to reduce the amount of unused
medications in the home can be a powerful tool to tackle prescription
drug abuse.\5\ Grandparents raising grandchildren as a result of the
opioid epidemic may want to keep unused medications out of reach of
their adult children still struggling with substance use disorder, as
well as their grandchildren, who are also at a higher risk of
developing substance use disorder themselves.\6\ The Comprehensive
Addiction and Recovery Act, passed in July 2016, empowers patients to
talk to their physicians and pharmacists about partially filling their
prescription medications in order to reduce the amount of unused
opioids available for misuse.\7\ Instead of picking up their entire
prescription all at once, patients would be able to take home a few
days' worth of medicine at a time, without having to get a new
prescription from their physician each time.
---------------------------------------------------------------------------
\5\ National Institute on Drug Abuse fact sheet (online at: https:/
/www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf).
\6\ ``Drugs, Brains, and Behavior: The Science of Addiction,''
National Institute of Drug Abuse (July 2014) (online at: https://
www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/
drug-abuse-addiction).
\7\ See S. 524: Comprehensive Addiction and Recovery Act of 2016
(online at https://www.Congress.gov/bill/114th-congress/senate-bill/
524/text).
Question: Do the grandparents you work with express concern about
having unused prescriptions in their home?
Response:
Anecdotally we find grandparents raising grandchildren are
conservative in their own use of opioid and other pain killers. Most
are well aware of the genetic and life experiences that their
grandchildren face and are thoughtful about keeping their medications
out of reach of children/youth in their care.
However, some caregivers report they need to hide their
prescriptions particularly when family members at risk of or struggling
with substance use disorders are visiting. When the prescription is
stolen by adult children, teenage grandchildren or neighbors, for
example, they cannot get more of their needed medication until the next
month which negatively impacts their own health and comfort.
Question: Would empowering grandparents to work with their physicians
and pharmacists to partially fill their prescriptions--while also
ensuring patients needing pain medicine receive it--help
grandparents keep unused medications out of the hands of those
struggling with substance use disorder, or those at a high risk of
developing it?
Response:
An option to partially fill prescriptions could be beneficial for
grandparents raising grandchildren who have concerns that the
medication may be stolen or taken by family members struggling with
substance use disorders. Furthermore, in the event the medication was
taken, caregivers would not have to wait a full month to refill their
needed prescription. It could also help low-income grandparents who are
unable to cover the cost of the entire medication at one time by
breaking down the cost throughout the month.
However, one of the major barriers to health care for grandparent
caregivers is transportation. Securing transportation to the pharmacy
once a month is often a hardship. Requiring them to go twice a month
would be twice as difficult. Any partial fill policy should be optional
and should include strategies to help address barriers related to
transportation to secure the medication.
Question: Are kinship navigator and support groups well-informed about
new federal partial-fill policies?
Response:
Within our extended network of caregivers and those serving them,
the majority reported that they were unfamiliar with partial-fill
policies.
Question: What sort of actions can be taken by states, physicians,
pharmacists, and patient and kinship groups to increase awareness
of the new federal partial-fill policy so that grandparents and
other kinship caregivers can take advantage of these options?
Response:
Our network of support groups, caregivers and practitioners have
expressed an interest and willingness to share information about
partial-fill policies through their support groups, informational
seminars, newsletters, community partner meetings, and through their
health and wellness programs.
Question: What other approaches do you think can be taken by states,
physicians, pharmacists, and patient and kinship groups to reduce
the amount of unused prescription medication in circulation?
Response:
Recommendations from our grandfamilies networks include:
Making available and easily accessible drop off and
disposal sites for unused medication.
For new prescriptions, providing samples to make sure the
caregiver can take the medicine without side effects or issues before
even fully or even partially filling a prescription.
Prescribing and including insurance coverage of
alternative pain management approaches such as acupuncture.
Providing education literature to support groups and
service networks about the availability of partial-fill policies,
alternative pain management approaches, and safe and accessible drop
off and disposal options.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Bette Hoxie, Executive Director, Adoptive and
Foster Families of Maine and the Kinship Program, Orono, ME
Good afternoon Chairman Collins, Ranking Member Casey and members
of the Special Senate Committee on Aging.
I am honored to speak with you today regarding both my professional
and personal experiences with this topic. My name is Bette Hoxie. I am
first and foremost a mother, grandmother, and great grandmother. I
raised my grandson since his infancy. Today he is 17 years old, and he
will graduate from high school in June. He plans to go into
conservation law enforcement after college.
I am also the executive director of Adoptive and Foster Families of
Maine Inc. and the Kinship Program.
Like so many other states, Maine is severely affected by the opioid
crisis that permeates our nation and its vulnerable families. More and
more infants are being born to mothers who are using opioids while
pregnant. These births are taking a toll on a population of caring
people who would--if they could--simply love their grandchildren, spoil
them, and send them home to be raised and nurtured by their parents.
But for an all too growing number of families, this is no longer an
option. Instead, the grandparents have become the primary caretakers.
Adoptive and Foster Families of Maine and the Kinship Program have
a great team of professionals working daily to support these
grandparents--who, in most cases, were never expecting to parent again.
They may not have a spare bed at home or clothing for the children. In
these instances, we are there to help. We collect new and gently used
items including beds, furniture, clothing, bedding and other material
goods, and provide them free to grandparents. If we do not have what a
grandparent needs in stock, we send out a request to the list serve,
and usually receive it within a few days. This office works with over
3,100 kinship families statewide--85 percent of the families are grand
or great grandparents. One-third of the total is licensed as the foster
parent to the child/children.
We also provide licensing and legal education. We guide
grandparents on how to work through Maine's Health and Human Services
system or gain guardianship through the Probate Court system depending
on where things are in time and space. We walk grandparents through the
licensing process, which can be lengthy, complicated, and costly. To
attain the license, grandparents must be mentally and physical fit to
care for children. We guide grandparents to medical providers in their
localities to attain physical and mental health assessments. In some
situations we are able to use donated funds to support grandparents
with the financial costs for filing paperwork and or finger printing if
they cannot afford it. Their home must also be licensed. It must meet
certain safety standards, including bedroom space and windows that meet
fire codes. Many of the older homes in Maine have small windows and do
not qualify. We try to work with the grandparents to come up with
solutions.
Our organization provides specific support groups so families can
share their stories and get emotional support from others like them who
are walking the walk and talking the talk! Childcare is provided for
children during the meetings so, like their caretakers, they are less
isolated and can learn that they are not the only child being raised by
grandparents. These support groups also serve as a mini respite for the
grandparents for that evening. In rural areas of Maine, where
transportation is difficult and families are unable to attend the
groups, mentors with similar life experiences are invited to assist the
families by phone. Respite is still a much-needed requirement for the
families served and it is very difficult to attain. Frequently at the
support meetings, families will develop their own respite amongst other
members.
We also provide kinship training. The training explains how DHHS
works and where to go for support. Relative caregivers participate and
share what they needed the most when they first started. We provide
referrals to appropriate legal guidance and mental health services, as
well as other resources as needed. For instance, we find that many of
the grandchildren have special needs, suffer from trauma, or may be
living with the effects of pre-natal substance abuse. We connect the
grandparents with resources to help, such as the Maine Autism Society
or the Maine Drug Awareness Program.
One of the most powerful sources of support for grandparents is to
meet others who are also raising their grandchildren. We organize a
statewide conference, which brings together grandparents all across the
state for education, training, and networking. We provide complimentary
registration to the first 20 new grandparents to participate and we
cover hotel accommodations for those who are coming from far away. When
the grandparents come together, they feel a sense of solidarity in
knowing that they are not alone, and they leave with a new set of tools
to support themselves and their grandchildren on their second parenting
journeys.
I mentioned earlier that I raised my grandson. Well, today--I am
also raising a 19-month-old boy. He is the nephew of one of my adopted
sons. The baby's biological mother is addicted to opioids. When I
agreed to raise my grandson nearly 18 years ago, I wondered if I'd be
able to walk down the aisle at his graduation. Now I find myself at 70
plus years of age wondering, ``Am I the right person to take on this
little boy?'' I am no stranger to caring for my children. I'm the
parent to 19 children and 40 grandchildren and 2 great grandchildren.
I work with families on a daily basis that resembles mine. Helping
the families understand that our small office is here really helps--
despite the fact that they know what they are struggling with includes
a long tough road ahead. Grandparents need to know that this country
supports them as well. Funds to meet the basic needs of families taking
on a relative's child needs to be a priority. There are barriers in the
foster care system but they are small compared to the needs in kinship/
grandparent care!
Many of the grandparents raising grandchildren had planned to be
retired. Others are younger and still raising children of their own in
addition to their grandchildren. Trying to make small or fixed-incomes
cover the costs of such things as diapers and childcare are often
insurmountable obstacles for the families who are giving their all to
keep our nation's children within their families of origin and above
all else safe!
Thank you for recognizing this important issue. I appreciate the
opportunity to share just a bit of what is happening in Maine both in
terms of what works and what continues to be challenging. I hope I can
respond to any questions and be useful as you work to support
grandparents raising their grandchildren who have been affected by the
opioid crisis.
__________
Prepared Statement of Sharon McDaniel, MPA, Ed.D., President and Chief
Executive Officer, A Second Chance, Inc., Pittsburgh, Pennsylvania
Chairman Collins, Ranking Member Casey, and Members of the
Committee, good afternoon and thank you for holding this hearing on the
effects of the opioid crisis on grandfamilies. As those who place the
well-being of children first and foremost, I first say to you,
``Kasserian Ingera'', meaning ``and how are the children?'' It is the
greeting of the Masai Warriors of Africa as they move from village to
village asking about the children, as they know it's their
responsibility to care for their young. I share in that same
responsibility with all my heart.
I am Sharon McDaniel, President and CEO of A Second Chance, Inc., a
leader in the provision of kinship care and support services in
Pennsylvania. I am also on the Board of Trustees of Casey Family
Programs, the largest national foundation dedicated exclusively to the
safety, permanency, and well-being of children in the child welfare
system.
Since 1994, A Second Chance has answered the call in meeting the
needs of over 21,000 children throughout the two largest counties in
Pennsylvania (i.e., Philadelphia and Allegheny). From time-to-time, we
have also serviced a few of the smaller counties. Many of these
children and youth were placed in the care of their maternal
grandmothers. In fact, over 65 percent of our current children and
youth are placed in the care of their maternal grandparents; where 40
percent are single female heads of household.
Each day, the dedicated staff of A Second Chance service over 1,800
children, their caregivers, and their birth parents. This does not
include the many uncounted grandfamilies who are outside of the system
and receiving very few supports.
My eyes have seen a lot throughout my 30-year career in child
welfare. I worked alongside families through the heartbreak of the
crack epidemic in the 90's. Today, the opioid epidemic is bringing
children into the system at earlier ages. Through crisis and
heartbreak, however, families can still triumph. Families do not lose
value in crisis. Thus, I am profoundly humbled and appreciative to be
able to share with you a couple of stories that elevate this
conversation from the pages of my notes to the imprinted visuals in
your heads about the importance of grandfamilies and the children that
they care for on a daily basis.
I will start with my own story . . . you see me! From the time that
I was 2 years old, I was placed in the care of my fictive grandparents;
they were not related by blood, but related by the heart. They were
members of my father's village. Following the tragic death of my
mother, my father sunk into a deep depression--which he attempted to
drink his way out of, and realized that this was not the life that he
wanted for his young children. Because the system had no real mechanism
for kinship care back then, we were placed with my grandparents as
foster children.
I witnessed, and was central to, all of the personal sacrifices
that my grandparents had to make for us, from child care to family
support. When we were school age, my grandmother used her foster care
payments to pay for those extra things that would support our
educational, cultural and social needs. She only wanted the best for
us.
Like my grandparents then, many grandparents want the best for
their grandchildren. Today, I am reminded of a grandmother I met last
year. She was 62 years old and had a successful career at Verizon when
she was suddenly asked to care for her five grandchildren due to her
daughter-in-law's opioid addiction. The family made these arrangements
outside of the child welfare system. Today, more than 2.5 million
children are in a similar situation due to their parent's inability to
care for them for a variety of reasons. Unfortunately, this grandmother
ended up losing her job. She and her grandchildren lived in a one-
bedroom apartment, had limited financial means and relied on TANF
child-only payments. She was unaware of any support that could help
with her overcrowded living conditions, including any support that the
Department of Aging could offer her or her grandchildren. Thankfully,
it was her faith community that stepped in and partnered with her to
fill in the gaps when and where needed. The grandmother said to me,
``Though I may not have much, my grandchildren are with me and not in
the system and we're gonna be all right!'' Her story is shared by many
other grandmothers across the country.
In Pennsylvania, I have seen a rise in the number of cases referred
to us by the public child welfare agencies in Philadelphia and, to a
lesser extent, Pittsburgh. In three years, the caseload in our
Philadelphia office has grown from 180 youth to over 900 children, many
under the age of five.
In Philadelphia, from 2014 to 2016, there was an 11 percent
increase in this age group. It is now at a staggering 56 percent. In
Pittsburgh, the percentage of children under five has been steadier at
around 48 percent. Because of the ages of these children and their
unknown medical histories, we immediately enroll them in CHIP, as we
must assess and follow up on their medical needs. It should be noted
that over 90 percent of the children we service are eligible and
receive Medicaid support.
Why the difference between the two largest counties in
Pennsylvania? Contributing to this difference is, in part, due to the
size of each county. Philadelphia is larger and hovers borders with New
York and New Jersey. There is a more diverse population as well. In
Allegheny County, we see an older population. We do, however, know that
trends traverse the state. We typically see what happens in the eastern
part of the state, slowly creep to western Pennsylvania three or so
years later, as we did with the crack and gang issues.
Consistent with national trends, the majority of these cases
involved parental neglect, which is often associated with drug
dependency issues. The opioid epidemic is reflected in the national
data on children in foster care. After years of declines, the number of
children in care grew from 378,912 at the end of FFY 2012 to 412,647 at
the end of FFY 2015. State and local child welfare officials attribute
this increase to the opioid epidemic. Many of these children are being
cared for by relatives. Of all children in foster care nationally, 29
percent are living with relatives.
In Allegheny County, 62 percent of children not living with
relatives are placed in kinship care, and in Philadelphia County, 47
percent are placed in kinship care.
Grandfamilies, both within and outside the child welfare system,
often lack the supports and services they need. Unlicensed relative
foster parents are typically denied the financial support provided to
licensed foster parents. Moreover, the vast majority of relative-headed
households have no involvement with the child welfare system and are
often unaware of the services and supports available to them.
In many areas of the country, particularly rural areas hit hard by
the opioid epidemic, those services are few and far between.
Grandfamilies affected by the opioid epidemic will tell you that they
need navigator programs which assist them with identifying and
accessing available services including mental health services,
financial assistance, counseling, support groups, legal assistance, and
respite care--all of which are essential. Furthermore, these services
must be available in urban, as well as, rural settings. Too often,
transportation, access to services, and child care have been cited as
barriers to grandfamilies.
Despite the challenges faced by relative caregivers, research has
shown that children experience better outcomes with kin than with non-
relative caregivers. These outcomes include fewer placement changes,
fewer school changes, increased likelihood of achieving permanency,
better behavioral health outcomes, increased likelihood of placement
with siblings and greater connections to community and culture.
The best place to touch grandfamilies is where they are isolated.
This isolation can come physically by way of their neighborhood or lack
of transportation. It can also come in the form of financial burden.
But perhaps the most critical isolation comes via the racial and
cultural prejudice grandfamilies experience. It is in the ageism they
face as caregivers. It is the unrecognized sacrifice they freely give
because they value keeping their families together--the families that
make up our Nation. What would we do as a Nation right now without
grandfamilies? Where would those 2.5 million children go? We must not
and cannot keep grandfamilies isolated any longer. What can be done to
support grandparents raising children in the midst of this
unprecedented crisis? Here are a few of my ideas:
1. Create a funding mechanism that blends federal child welfare
and aging dollars to prevent the need for children to come into care.
Let's get on the front end of this issue. Grandfamilies should not have
had to lose their jobs to support their grandchildren.
2. Create more community support centers like the KARE Center in
Arizona which is supported by Casey Family Programs in partnership with
Arizona Children's Association. Additionally, create more holistic
community-based kinship care programs like A Second Chance where
families and their children can go for support services that are needed
before removal of children becomes necessary.
3. Ensure that Senior Centers are equipped to support grandparents
raising grandchildren with housing vouchers, support groups, counseling
and in-home services, financial support and respite care.
4. Create more effective and readily available Drug Treatment
Centers that treat the entire family. Grandfamilies need to understand
how to negotiate the complexities associated with drug addiction and
the impact on the children for whom they provide care for on a daily
basis.
5. Re-examine the core tenets of the former Families First draft
legislation. In order for grandfamilies and their grandchildren to
receive services without the need to enter the child welfare system,
flexible finance reform in child welfare is necessary and essential.
As I was preparing my remarks for you today, I decided to consult
the real experts and asked grandmothers who were attending a recent
Grandma's Hands Support Group sessions at my organization what they
would say to Members of Congress about what they needed. They told me
this:
``We do what we do because we love our grandchildren and our
families. We need your help and cannot do what we do without the love,
support, and suspended judgment of those we interact with each day.
Treat us as if we were caring for your own grandchildren.''
Thank you Ms. Chairman and Members of the Committee for the
opportunity to share my thoughts with you today.
__________
Dr. Sharon McDaniel
Response to Questions for the Record
Sentor Elizabeth Warren
Opioid Epidemic and Partial Fill Policies
Older patients are frequently prescribed painkillers for chronic
pain, or after surgery or other procedures.\1\ The Center for Medicare
and Medicaid Services (CMS) reported that generic Vicodin was
prescribed to more Medicare beneficiaries than any other drug in
2013.\2\ In 2015, almost 30 percent of Medicare Part D enrollees used
an opioid prescription.\3\ If older adults don't use their entire
prescription, these pills can remain in the home--and the National
Institute on Drug Abuse has estimated that over 70 percent of adults
who misuse prescription opioids get the medication from friends or
relative.\4\
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\1\ Ibid.
\2\ Centers for Medicare & Medicaid Services, ``CMS Releases
Prescriber-Level Medicare Data for First Time'' (April 30, 2016)
(online at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-
sheets/2015-Fact-sheets-items/2015-04-30.html).
\3\ Paula Span, ``New Opioid Limits Challenge the Most Pain-
Prone,'' New York Times (June 6, 2016) (online at: https://
www.nytimes.com/2016/06/07/health/opioid-limits-older-patients-
pain.html).
\4\ National Institute on Drug Abuse fact sheet (online at: https:/
/www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf).
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As a consequence, efforts to reduce the amount of unused
medications in the home can be a powerful tool to tackle prescription
drug abuse.\5\ Grandparents raising grandchildren as a result of the
opioid epidemic may want to keep unused medications out of reach of
their adult children still struggling with substance use disorder, as
well as their grandchildren, who are also at a higher risk of
developing substance use disorder themselves.\6\ The Comprehensive
Addiction and Recovery Act, passed in July 2016, empowers patients to
talk to their physicians and pharmacists about partially filling their
prescription medications in order to reduce the amount of unused
opioids available for misuse.\7\ Instead of picking up their entire
prescription all at once, patients would be able to take home a few
days' worth of medicine at a time, without having to get a new
prescription from their physician each time.
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\5\ National Institute on Drug Abuse fact sheet (online at: https:/
/www.drugabuse.gov/sites/default/files/poppingpills-nida.pdf).
\6\ ``Drugs, Brains, and Behavior: The Science of Addiction,''
National Institute of Drug Abuse (July 2014) (online at: https://
www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/
drug-abuse-addiction).
\7\ See S. 524: Comprehensive Addiction and Recovery Act of 2016
(online at https://www.Congress.gov/bill/114th-congress/senate-bill/
524/text).
Question: Do the grandparents you work with express concern about
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having unused prescriptions in their home?
Response:
At a Second Chance, Inc., we have not heard this directly from our
grandparents, but I believe that they are so overwhelmed with other
issues, that have not had time to consider this concern. Grandparents
need to deal first with the basics including a safe and appropriate
sleeping space, getting the child to their original school or
registering them in a new school and dealing with the trauma of
removal. Grandparents are also dealing with their own emotions.
It would be good to have information available in the cases where
it could be an issue in the household.
Question: Would empowering grandparents to work with their physicians
and pharmacists to partially fill their prescriptions--while also
ensuring patients needing pain medicine receive it--help
grandparents keep unused medications out of the hands of those
struggling with substance use disorder, or those at a high risk of
developing it?
Response:
This needs to be determined on a case by case basis. Among
grandparents who are responsible for their grandchildren:
58 percent are still in the workforce
21 percent live below the poverty line
26 percent of them are disabled
Given these statistics, requiring grandparents to make multiple
trips to a pharmacy could add an additional and unnecessary burden to
the family route. It would depend on ease of access to transportation
to the pharmacy, the hours of the pharmacy in relation to the
grandparents work schedule and a range of factors. Advising
grandparents of all their options and helping support their decisions
would be the best approach.
Question: Are kinship navigator and support groups well-informed about
new federal partial-fill policies?
Response:
To my knowledge, kinship navigator programs are not focused on this
option because of the wide range of unique issues that must be
otherwise addressed.
Question: What sort of actions can be taken by states, physicians,
pharmacists, and patient and kinship groups to increase awareness
of the new federal partial-fill policy so that grandparents and
other kinship caregivers can take advantage of these options?
Response:
Public awareness campaigns and information provided by physicians
and pharmacists could be an effective way to provide options for
grandparents. Supporting and expanding kinship navigators to allow them
to provide broader support would also help.
Question: What other approaches do you think can be taken by states,
physicians, pharmacists, and patient and kinship groups to reduce
the amount of unused prescription medication in circulation?
Response:
Grandparents raising their grandchildren have enormous demands on
their time and their energy, and 39 percent of them are over 60 years
old. It is very important to have supports that are convenient and
accessible. Transportation to pharmacies or other prescription drug
drop off programs can be a challenge. Allowing grandparents to return
unused prescription needs to be convenient and part of their existing
routine to be the most effective.
Another important approach is professional training. We know that
research demonstrates the unconscious nature of bias against older
caregivers. Given the current opioid epidemic and its impact on
grandfamilies, we must consider implicit bias measures and training
because they can illuminate hidden ageism with older care-givers. For
instance, we cannot make assumptions that grandparents are not
conscious of leaving drugs out in the open due to their age or that
there is an automatic need for partial-refills regarding seniors.
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