Reaching and Serving Informal Kinship Caregivers in Washington State: An Implementation Analysis on the Lived Experiences of Informal Kinship Caregivers and Kinship Navigators

Background and Purpose: Informal kinship caregivers comprise the majority of caregivers of maltreated children who cannot stay safe with their biological parents, especially grandparent-headed households (U.S. Census Bureau, 2023). Despite sharing similar challenges and service needs, informal kinship caregivers receive significantly less support and services compared to their formal counterparts (Denby, 2015; Pittman, 2023). The disparity persists in benefits and service opportunities between these two groups (Smith, 2018). However, kinship navigator programs (KNPs) can address this imbalance by catering to both formal, licensed kinship caregivers and informal, unlicensed caregivers. Kinship navigators help families negotiate complicated eligibility criteria, service gaps, and access barriers that exacerbate racial and class inequities. Given low service utilization and high needs among informal caregivers, programs must actively promote uptake (Gleeson, 2020). Despite current federally-recognized evidence on utilization's importance for formal caregivers, gaps remain regarding street-level implementation impacting informal caregivers attending KNPs. This qualitative study addressed this gap.

Methods: This study analyzed qualitative data from four focus groups involving informal kinship caregivers (N=37) from rural and urban counties, and one focus group with kinship navigators (N=8) in Washington State. The data was collected from a university-service agency partnership using a community-engaged research (CEnR) approach. Semi-structured interviews were conducted, with one focus group involving kinship navigators to collect their lived expertise on service delivery, program implementation, fidelity monitoring, and perspectives on service utilization of kinship caregivers attending the KNP. Additionally, four focus groups were conducted to gather informal kinship caregivers' lived experiences of service utilization through the KNP. First, using the RE-AIM framework (Glasgow et al., 2019) as an analytic framework, direct content analysis (Hsieh & Shannon, 2005) was performed through deductive coding and focused coding techniques (i.e., strength of codes). Second, an inductive qualitative thematic approach (Braun & Clarke, 2006) was applied to identify emerging themes from the coded data.

Results: The findings primarily addressed the reach, effectiveness, and implementation aspects of the RE-AIM framework. Rural caregivers faced challenges including limited access, transportation barriers, awareness gaps regarding available resources, and a scarcity of tailored programs and financial aid for non-foster caregivers. Navigators focused on outreach strategies, expanding program reach, comprehensive collaboration, eligibility criteria, serving diverse populations, and securing sustainable funding. Informal kinship caregivers, drawing from lived expertise, voiced multifaceted challenges encompassing legal processes, financial constraints, accessing support services, and managing intergenerational family dynamics. They encountered difficulties with paperwork, healthcare systems, and obtaining financial aid. Navigators played a crucial role by offering information, facilitating support groups , and making referrals (e.g., legal assistance, educational support, childcare, respite care). Nevertheless, informal caregivers encountered accessibility and awareness issues, necessitating enhanced outreach, communication, and expanded coverage. Financial constraints, legal issues, eligibility criteria, and income limitations impeded access to support, highlighting the need for addressing these barriers. Despite challenges, community connection, shared lived experiences, self-care opportunities, respite care, parenting knowledge, and vicarious resilience through support groups were pivotal for caregiver well-being and enhanced informal kinship care.

Conclusions: Service utilization behaviors of informal kinship caregivers and the service utilization-delivery gap should be addressed.