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Exemplary Programs

Assessing and Meeting Caregiver Needs

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Grandfamilies & Kinship Support Network: A National Technical Assistance Center EXEMPLARY Policy/Practice seal

We are pleased to share profiles detailing four Exemplary kinship practices, all of which are effectively assessing and meeting caregiver needs:

These practices help caregivers explain their challenges and offer real assistance to enable the caregivers to address and overcome their difficulties. We encourage readers to consider how they can replicate these practices in their communities, and to reach out to us for assistance.

Family Needs Scale – Kinship Support Services Program, Wayfinder Family Services (California)

Practice Description

The Kinship Support Services Program at Wayfinder Family Services uses its Family Needs Scale to understand and respond to the immediate needs of kinship families both inside and outside the child welfare system. The use of this evidence-based tool is an exemplary practice because it ensures that all kin caregivers are asked the same questions, and it prompts caregivers to consider a wide range of areas in which support can be helpful.

Provided in both English and Spanish, the scale was adapted from another family needs scale found in a 1988 book, Enabling and Empowering Families: Principles and Guidelines for Practice. The Family Needs Scale is intended to be administered during the initial meeting between the caregiver and kinship navigator. It asks kin caregivers about the frequency with which they would benefit from:

  • Someone to talk to
  • Access to health care
  • Help with parenting
  • Legal services
  • Housing assistance
  • Concrete goods
  • Substance abuse treatment
  • Assistance meeting basic needs

Kinship navigators ask kin caregivers who are completing the scale to be as honest as possible in their answers, assuring them that their answers will not impact their ability to receive services or funding in any way and will remain confidential to external agencies. Results from the scale determine whether a kinship family receives information and referral services or intensive case management services through Wayfinder’s Kinnections kinship navigator program.

For kinship families who are identified to receive case management services, the scale helps guide those services. Using the caregiver’s answers to the scale, the kinship navigator and the caregiver work together to outline the most essential goals for case management services, which then inform the creation of the Family Service Plan.

Partnership and Collaboration

Wayfinder collaborates with and refers families to local agencies and organizations based on the needs identified in the scale. They have referral relationships with county child welfare agencies, aging services, educational programs, housing providers, Medicaid, and economic support programs such as Temporary Assistance for Needy Families (TANF), among others.

Evidence and Continuous Quality Improvement

The efficacy of the scale in accurately identifying each family’s greatest needs is demonstrated as families sign off on their Family Service Plan goals. Aggregate outcomes data shows that the scale is contributing to the overall goals of the kinship navigator program. Additionally, a 2016 study identified the original 1988 version of the Family Needs Scale that Wayfinder adapted for their use as showing promise in measuring kinship families’ needs. A 2024 study validated the 1988 version of the tool in “assessing current kinship needs and outcomes.”

Wayfinder uses a tool called PDSA (Plan-Do-Study-Act) to assess the impact of tools they use, including the Family Needs Scale, and make necessary changes.

Tips for Replication

  • Review the family needs scale in partnership with the kin caregiver, rather than having the caregiver complete it themselves. The tool works best when it is used to guide conversations with the caregiver, bringing out their true level of need for services and deterring them from minimizing their need for help. Realizing that a conversational approach to assessing needs takes time, plan to allot at least 60 minutes for the assessment process. Also, make an effort to administer the scale in a comfortable and private setting.
  • Include demographic, financial, and biographical information in the scale to provide context for the assessment. That context can identify what resources and support the family may already have in their community, as well as potential challenges to accessing resources, particularly those that address social determinants of health.
  • Train new kinship navigators on the family needs scale. Wayfinder recommends using it to teach them about kin caregivers’ needs and training them in how to ask the questions in a way that will build rapport and trust with the caregiver and help the navigator and caregiver identify needed support together.
  • Establish relationships with trusted community partners and systems that serve kinship families before administering a needs scale. If the scale is assessing particular service needs, make sure to have appropriate and reliable places to refer families to meet those needs.

Additional Practice Resources

To learn more about this practice, review the Family Needs Scale.

Kinship Navigation App – Alaska Impact Alliance

Practice Description

The 907 Navigation App is a digital platform that launched in early 2025 in response to the overwhelming and fragmented system of care that families in Alaska often face when seeking support for mental health, substance use, education, housing, or parenting. The Alaska Impact Alliance built the app, with state agency and relative caregiver partners, to connect Alaskans to real-time, geolocated resources. It is user-friendly and free to use for any Alaskan.

The app is free to download on any smart device and can be used on a desktop computer. It includes customized navigation pathways based on a user’s profile (e.g., caregiver, youth, parent) and offers step-by-step guidance for accessing services and applying for assistance. It integrates lived-experience-informed design, ensuring the app reflects what families need. The app is available in 13 different languages. The multi-language approach allows the app to reach Alaskans across the entire state.

For relative caregivers, especially in rural or underserved areas, finding accurate, up-to-date resources can be frustrating and time-consuming. Many families report being bounced between agencies, being given outdated information, or being unable to find culturally relevant, trauma-informed services. The app, while new, is an exemplary practice that is connecting rural kinship families to essential services. It helps families navigate complex systems with dignity and autonomy.

Partnership and Collaboration

The Alaska Impact Alliance developed the 907 Navigation App using information gathered from dozens of Alaska systems and agencies to ensure comprehensive, accurate, and user-centered content. They worked with staff across Tribal organizations and health entities, as well as several state agencies, including Behavioral Health, Juvenile Justice, Public Assistance, Senior and Disabilities Services, Children’s Services, and Corrections. Each partner contributed information within its area of expertise to inform the app’s content and navigation pathways.

Relative caregivers were actively involved in the development of the 907 Navigation App, helping identify priority systems, resources, and content they wanted support navigating.

The app incorporates ongoing feedback from professionals, Tribal partners, and kin caregivers, with recommendations regularly integrated into updates. A part-time staff member of the Alaska Impact Alliance continuously monitors the app to ensure information remains current, accurate, and responsive to user needs.

Evidence and Continuous Quality Improvement

The 907 Navigation App does not collect individual user data but tracks downloads, location and language choices, resource and systems navigation favorites, chat bot use, and eligibility calculator use. Since the app’s launch in early 2025, it has seen 5,200 downloads, with approximately 47 new downloads each week.

The effectiveness of the app is largely measured anecdotally by feedback given from both professionals and kin caregivers. Child welfare workers are using the app to help build their safety plans, and relatives are using it to learn what resources they can access. A kin caregiver raising two children told Network staff that this app is “the easiest way to share and get access to all of the services and resources in Alaska.”

Tips for Replication

Charity Carmody, executive director of the Alaska Impact Alliance, notes that a key part of developing an app like this is finding sustainable funding. The upfront cost for web developers is the biggest expense.

It is important to budget for the salary of at least one staff member to spend at least 20 hours a week monitoring and updating the app as needed.

To help other programs that want to develop a similar navigation app for their area, the Alaska Impact Alliance would be pleased to share their design. Other programs can apply or adapt the design to their own community or state. The Alliance is also willing to connect interested jurisdictions with their designer.

Additional Practice Resources

To learn more about this practice, review the following links:

A Partnership to Streamline Access to Public Benefits – Foster Kinship (Nevada)

Practice Description

A key component of the federally approved, evidence-based Kinship Navigator Program at Foster Kinship is their innovative partnership with the Nevada Division of Supportive Services (DSS) to streamline access to public benefits for kinship families. This practice is exemplary because of its integrated, caregiver-centered approach. It is a model of cross-system collaboration that meets the urgent needs of kinship families, reduces barriers to accessing services, and supports long-term family stability within a trauma-informed framework.

Recognizing the complex and often overwhelming process caregivers face when applying for public benefits (i.e., TANF Child Only, DSS Kinship Care payments, the Supplemental Nutrition Assistance Program (SNAP), and Medicaid), Foster Kinship collaborated with DSS to create a direct, accessible solution: stationing two DSS workers at the nonprofit’s Las Vegas office, Tuesday through Friday, 9 a.m. to 5 p.m. This practice removes common barriers faced by kin caregivers, such as long processing times, transportation challenges, confusion around documentation, and fear or frustration navigating public systems.

When kinship families contact Foster Kinship’s Navigator Program, a family advocate conducts a comprehensive intake assessment to understand the family’s needs and identify available resources, including potential eligibility for DSS public benefits. If the family wishes to apply for benefits, they are scheduled for a navigator case management appointment. At the case management appointment, the family advocate assists the family in completing necessary paperwork, collecting required documentation (e.g., identification, birth certificates, Social Security cards, income verification), and preparing for their DSS interview. Foster Kinship then schedules an onsite benefits interview with a DSS worker. By working together, DSS staff and the Foster Kinship family advocates overcome unnecessary bureaucratic delays, and the families get quicker, often same-day, approvals.

Foster Kinship offers this service to any family they serve who meets the eligibility criteria to receive public benefits. This includes both kinship families who are involved in the child welfare system and those who are not, and kin caregivers of all ages and relationships to the child they are raising. While Foster Kinship serves kinship families across the state, the onsite DSS workers serve families in Clark County, which is by far the most populous county in the state, with 75% of the state’s kinship families. The DSS workers can also process and approve certain applications from kinship families outside of Clark County, if an in-person interview is not required.

Foster Kinship partnered with DSS to implement this practice in 2021, with one onsite worker, and requested a second worker in 2023 due to the volume of appointments.

Partnership and Collaboration

DSS outreach workers are employed, supervised, and paid by the state department but are located onsite at Foster Kinship and attend Foster Kinship staff meetings. DSS communicates with Foster Kinship management staff regularly to ensure policies are being followed.

The practice was created in response to concerns voiced by kin caregivers about difficulties accessing public benefits. Many caregivers, especially those outside the formal child welfare system, reported struggling to get benefits approved at district DSS offices, where staff members were unfamiliar with the specifics of TANF Child Only and the unique circumstances of kinship care. Kin caregivers faced challenges, including language barriers, document collection, long wait times, limited access to transportation, and the need to take time off work to attend walk-in appointments.

Everything we do is based on kinship feedback.

Foster Kinship Staff Member

Evidence and Continuous Quality Improvement

Foster Kinship’s partnership with Nevada’s DSS outreach program is an effective practice that has resulted in more families receiving public benefits, including TANF Child Only, SNAP, and Medicaid. In 2024, Foster Kinship completed over 550 DSS application sessions with families, with an average of 10 to 12 DSS interviews weekly.

At the close of every kinship navigator case, Foster Kinship sends the kin caregiver a satisfaction survey to assess their experience with Foster Kinship’s services, including benefits access. Foster Kinship staff members reported that they receive a lot of surveys back from caregivers who are satisfied with the services and support they received, with an average rating of 4.95 out of 5. Dr. Ali Caliendo, founder and executive director of Foster Kinship, reviews the survey responses and incorporates the information into reports to the Board. She also explained that staff members reach out directly to families who report not being satisfied so they can address issues quickly.

In addition to the satisfaction surveys, Foster Kinship was externally evaluated. One of the key findings was that families utilizing the program were 2.5 times more likely to receive TANF Child Only from the State of Nevada than kinship families that did not utilize the program. Foster Kinship is a federally approved evidence-based Kinship Navigator Program included in the Title IV-E Prevention Services Clearinghouse.

Tips for Replication

Foster Kinship staff members explain that the practice requires the following:

  • A customer relationship management (CRM) platform and scheduling system (Foster Kinship utilizes Salesforce and Calendly).
  • Training for family advocates on TANF Child Only, SNAP, and Medicaid, and access to state application documents and manuals.
  • Screening and assessment tools, including a thorough intake process, so the majority of information needed to apply for benefits is already collected and can be assessed for eligibility before the caregiver meets with the state DSS worker. Foster Kinship staff members expressed the importance of both (1) being able to translate the complex requirements for accessing public benefits for kin caregivers and (2) acting as a liaison between the kin caregiver and state worker to make the process as streamlined and successful as possible.
  • Office space to host state workers.

Tangible Goods and Emergency Financial Assistance for Families – Kinship Support Program, YMCA Youth & Family Services (California)

Practice Description

Since 2014, the YMCA of San Diego County, Youth & Family Services Department has provided emergency financial assistance and concrete goods, through their Kinship Support Program, to all kinship families in the County, whether foster-care involved or not. Funds are flexible and responsive to the family’s needs. The Kinship Support Program can assist with expenses – including child care, utility bills, or car repairs – and purchase goods such as cribs, beds, or car seats. The YMCA of San Diego County was one of the early trailblazers in providing concrete goods and emergency assistance to kinship families, and the responsive, flexible, and ever-expanding nature of this practice is what makes it exemplary.

While funding is tailored to each family’s unique needs, common patterns have emerged. For example, the Kinship Support Program has found that many caregivers outside of the child welfare system take in young kin children unexpectedly, and caregivers need immediate child care so they can continue to work full-time. As a result, the Kinship Support Program often uses emergency funding to pay for one or more months of child care, until a family’s kinship navigator can connect the kin caregiver with longer-term solutions, such as public benefits and subsidized child care programs.

Kin caregivers can self-refer to the Program and are assessed by kinship navigators to determine their need for financial assistance or goods and services. The Kinship Support Program also receives requests from County social workers and processes those requests within one business day. 

The Kinship Support Program receives funding from the County to finance the tangible goods and emergency assistance. They are also able to utilize grant funds from the

May and Stanley Smith Foundation when County funding is not an option. In addition, since 2022, the Kinship Support Program has utilized a national, online platform called CarePortal that partners with local, faith-based organizations to provide concrete goods and services to families. 

Partnership and Collaboration

The voices of kin caregivers shaped the development and implementation of this practice, as the Kinship Support Program heard from caregivers about their barriers to stability, which could often be resolved with financial support.

The Kinship Support Program has two primary partners to implement this practice: County of San Diego Child and Family Wellbeing (CFWB) and a faith-based organization called Restoration225 (R225). 

CFWB contracts with the YMCA of San Diego County to provide kinship navigation/case management, support groups, respite care, emergency funds, and family events. Through this contract, the Kinship Support Program is able to implement its practice of utilizing emergency funds to purchase goods and services to provide stability to families they serve. 

Additionally, the Kinship Support Program partners with R225 through CarePortal, which allows the Program to share confidential requests for needed items and services for families. Once submitted, requests are forwarded to partner churches throughout the County, and the churches answer requests as they are able. In many cases, church members meet an immediate need for groceries or clothing and also establish a longer-term relationship with caregivers to provide ongoing emotional support, meals, groceries, and even respite care. For example, a group of church members volunteered to clean and organize the yard and home of an older, disabled kin caregiver so the family could have a safer and more comfortable living space. 

Evidence and Continuous Quality Improvement

Last fiscal year, the Kinship Support Program provided $331,000 in emergency funding to 328 unduplicated clients (an average of $1,009 per kin caregiver). During the same time period, requests met via the CarePortal platform served 101 children, with an economic impact of $97,951.

To evaluate and improve the effectiveness of the practice, staff members administer post-service assessments and annual client satisfaction surveys, and they make programmatic changes as indicated. Staff members also meet weekly to raise any issues with their resource provision process and adapt that process as needed.

Tips for Replication

  • Pay most expenses directly to the vendor, rather than to the family, so that you can better track their use and impact. For example, in consultation with the kin caregiver, purchase goods directly by making an online order or pay for a service by writing a check to the provider, like a car repair shop.
  • Consider assigning a single person to process and track requests daily and decide on a request amount that requires an additional layer of approval. For the Kinship Support Program, the program operations manager is responsible for processing and tracking requests in an Excel spreadsheet. Requests of over $1,000 require oversight approval.
  • Keep emergency funds requests separate from other referrals, such as kinship navigator referrals, to avoid delays in the disbursement of emergency funds.
  • Try to hit the sweet spot of making the form for requesting funds comprehensive but not too overwhelming, to avoid multiple conversations and follow-up questions that might feel burdensome or intrusive to a family and to reduce the likelihood that an overly complicated form will intimidate or scare people away. See below for a link to the form the Kinship Support Program uses, and feel free to replicate and adapt it for your own purposes.
  • Seek funding that is flexible and avoid limiting the use of emergency funds to a prescribed list of purposes. Kinship Support Program Social Service Director Melissa Brooks acknowledges that there is always a push-pull between adhering to funding guidelines and meeting a family’s needs, and she emphasizes the importance of flexibility. The YMCA’s contract with the County explicitly allows for the use of their funding to be responsive to family needs and is not limited to a specific list. 

Additional Practice Resources

To learn more about this practice, review the links below.

Learn More about the Network’s Exemplary Practice Designation

If you have questions about any of the practices profiled here or are interested in learning more or replicating one of these practices, please complete this short form and we will get back to you.

For information about the steps and criteria of the Exemplary designation process, please click here.

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