Voices from the Field

The Supportive Older Women’s Network (SOWN) created the GrandFamily Resource Center (GFRC) to serve grandparents raising grandchildren. Read this interview with SOWN staff to learn more about the evolution of the GFRC to include the integration of peer support groups and behavioral health services in primary care settings.

May 2019

The opioid crisis has placed a national spotlight on the increased number of grandparents raising grandchildren. More than 2.5 million grandparents nationally and 15,379 grandparents in Philadelphia are primary caregivers for grandchildren—a number that includes many families who have been affected by substance use disorder (American Community Survey 2013 – 2017). Community organizations like PHP grantee Supportive Older Women’s Network (SOWN) have a deep practice base of experience that can inform long-needed efforts around the country to increase resources and supports for kinship caregivers.

In summer 2018, Congress passed the Supporting Grandparents Raising Grandchildren Act, establishing an advisory council to “identify, promote, coordinate, and disseminate to the public information, resources, and the best practices” to promote the health and well-being of grandparent-headed families. Co-sponsored by Senator Bob Casey (PA) with Senator Susan Collins (ME), the act was a testament to advocacy efforts that have elevated the voice of community organizations like SOWN who have been working to provide care and services to grandmothers and grandfathers raising grandchildren over many years.

SOWN’s related experience dates from the launch of the GrandFamily Resource Center (GFRC) in 2006. With PHP support, SOWN expanded GFRC programming in 2016 to provide peer supports and behavioral health services in primary care settings through a partnership with Family Practice and Counseling Network. In the following interview, SOWN team members reflect on what they have learned from the development of the GFRC and integrated care model.

What drives your work at Supportive Older Women’s Network?

At SOWN, our mission is to support adults 50+ lead independent, healthy lives and age in place in their homes and communities. Research shows that isolation can cause not only depression, loneliness, and anxiety but also health changes: isolated older adults and caregivers experience much higher rates of mortality from common chronic illnesses. Social relationships have as much impact on health as smoking, blood pressure, and obesity. In fact, one study (see reference to right) found that social isolation has as much impact on health as smoking 15 cigarettes a day!

Since our founding in 1984, SOWN has facilitated peer support groups and workshops at community-based partner sites in Philadelphia and facilitated teleconference support groups for homebound adults. The core premise of our service model is that physical health and social connectedness are intricately tied to emotional well-being.

Why did SOWN start the GrandFamily Resource Center?

Over time, as SOWN grew and our work in communities deepened, we recognized the significant role that older adults play in maintaining families. We started the GrandFamily Resource Center (GFRC) in 2006 in recognition of the unique demands placed on grandparents raising grandchildren. In our experience, members of both generations have often had significant experiences with trauma from parental incarceration, abuse, neglect, death, domestic violence, and/or substance use disorder that makes access to behavioral and mental health services critical. SOWN’s particular expertise, harnessing the power of the peer group to facilitate growth and healthy behavior change, is an effective tool for addressing the long-term impacts of these exposures.

The purpose of the GFRC is to support grandparents in keeping their grandchildren healthy, out of foster care, and in a stable secure environment; to improve grandparents’ communication and parenting skills; and to support GrandFamilies to develop healthier lifestyles and gain strength and resiliency. Through the GFRC, GrandFamilies can access support groups, individual counseling, crisis intervention, parenting education, and information and referral among other services and supports. As one of our grandparent participants attested, “When you are raising grandkids, you feel you are the only one. But I am telling you, there’s two or three of us on almost every block in the city. And for us to get together to help each other, that’s beautiful.”

The GFRC is based on a peer-driven support model with a high level of involvement and participation of the grandparents. Grandparents are involved in identifying their needs and designing programs and interventions to address these needs. We do this through skilled group facilitation that empowers the group to be the decision-maker. The grandparents identify session topics they need to explore and provide input into the timing and structure of the activities. Some of the workshops focus on topics relevant to parenting, such as a recent offering that discussed communicating about sexuality with teenagers.

Other workshops focus on topics related to both generations’ health and wellbeing. For instance, Sadie, age 66, expressed that after participating in SOWN’s workshop, Learning to Live with Diabetes, “I’m learning how to keep my sugar under better control. I am cooking differently for the grandchildren too ‘cause I don’t want them to get diabetes.” Martha, age 69, shared that, “learning to cook healthier in African heritage session will change how my family prepares and eats our meals.”

In addition to providing access to direct services and supports, cultivating leadership in older women is an essential component of all of SOWN’s work. SOWN’s volunteer Grandparent Ambassadors serve as leaders in their communities, working to recruit GFRC participants, give voices to the needs and priorities of GrandFamilies, and advocate for policy change. In the context of GFRC workshops, grandparents regularly take on leadership roles mentoring other members and providing peer coaching. For example, recently a 93-year-old great grandmother raising her 16-year-old grandson helped another group member struggling with her teenage grandson. She said, “Girl, you can do this. I’ve been there. I thought I could never do this job, but I can, and you can too!”

What does the integrated care model add to the GrandFamily Resource Center?

In 2015, we received a grant from Philadelphia Health Partnership (then First Hospital Foundation) to expand the GFRC in 2016 to reach GrandFamilies in primary care settings. By housing GFRC programming in Federally Qualified Health Centers (FQHCs), we aimed to increase the access of high-need grandparent-headed families to comprehensive behavioral health services, health care, and wellness services. We felt that offering our services at health centers would minimize the stigma and discrimination associated with seeking support, while increasing coordination of care to improve overall health outcomes for both grandparents and children.

Today, the GFRC offers programming in three FQHCs – 11th Street Family Health Center, Abbottsford Falls Family Practice, and Stephen Klein Wellness Center – and serves 47 grandparent-headed families raising 69 children—100% who have household incomes below the federal poverty line. At each site, we provide weekly group treatment, individual counseling and crisis intervention as needed, bi-monthly healthy living wellness workshops, and quarterly educational events for grandchildren and grandparents together. As program coordinator, Arlene Segal, a Master’s-level clinician with over 30 years of experience, works closely with health center staff and administrators to provide joint programming—from workshops on trauma-informed care principles and intervention strategies to hands-on classes on nutrition, cooking, mindfulness, and yoga.

Arlene also facilitates “warm hand-off” referrals, connecting grandparents directly with health center professionals to arrange assessment or care for either grandparents or grandchildren. For instance, one participant, Annie, age 70, said, “I hadn’t been to the dentist in over five years. I was in a lot of pain but was always scared of dentists. Sarah, one of the SOWN grandparents said to me, ‘the dentists here are gentle, and it’s easy to get an appointment.’ I trusted what she said, and she was right.” Another participant, Edward, age 70, reported that his two granddaughters, ages four and six were struggling to understand why they weren’t living with their parents: “I took them to the therapist here at the FQHC because I knew they would get the care they needed.”

How do you define success in the GFRC?

We assess the quality of our work by evaluating the knowledge and skills that grandparents gain through our programming as well as the well-being of the children. In our most recent outcomes data from Fiscal Year 2018, the majority of GFRC participants reported that they:

  • Learned and would use techniques for positive discipline for coping with their grandchildren (88%);
  • Learned and would use information about how trauma affects brain development and impacts children’s behavior (86%);
  • Learned and would use knowledge gained about the importance of healthy eating and fitness for themselves and their families (89%);
  • Gained better parenting skills (100%).

Now that our services are firmly established at our partner FQHCs, we are excited to try new approaches to determining whether GrandFamilies are more likely to use primary care, dental care, and behavioral health services after participation in SOWN programming at the FQHC sites.

SOWN’s GFRC has a unique lens, in Philadelphia and nationally, in focusing on the multi-generational needs of both the grandparents and the grandchildren. We know that these families have complex, multiple, and interdependent needs, and real change occurs when we address the entire family. Our outcomes reflect the value of this approach. In Fiscal Year 2018:

  • 100% of grandparents in the GFRC program reported enhanced well-being, increased social connection, and decreased social isolation as a result of participation.
  • 100% of the grandchildchildren continued living in a stable home with a grandparent, received regular health and dental care, were enrolled in school, and attended school regularly.

These statistics demonstrate the impact of SOWN’s model. With the increasing number of grandparent-headed families in Philadelphia and across the country, innovative programs to support healthy outcomes for these families are urgently needed. Ultimately, we believe that the power of our work is older adults helping each other, and in doing so, helping themselves and their grandchildren!