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Exemplary Programs

High Country Caregivers – North Carolina

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Seal with the Grandfamilies & Kinship Support Network: A National Technical Assistance Center logo above the word

High Country Caregivers (HCC) was founded in 2006 and has quickly become a leading organization in western North Carolina that addresses the growing population of kin caregivers raising children. HCC uses a strategic and comprehensive relationship-building approach to support kinship families; they carry out this approach by offering support groups, legal assistance, concrete supports, kinship navigation, mentorship, nature adventure programs for youth, respite care events, family holiday parties, and a wide array of other supports. As stated on their website, HCC aims to offer “whole-family care to empower caregivers who take on the responsibility of caring for a relative or friend’s child.”

High Country Caregivers has built a distinguished kinship navigator program in response to the needs of the High Country area, recognizing the impact the opioid crisis had on the people of Appalachia. While HCC is relatively new (having been formed within the last 20 years), the people in this region have been caring for relative children for generations. Recognizing the strong history of self-reliance, HCC seeks to offer support that is empowering. They seek to eliminate the “us versus them” paradigm, building programming and support in a collaborative way that is attentive to the needs of the culture and history of the High Country.

Eligibility for Services and Intake

High Country Caregivers provides services for any kin caregiver in their service area, regardless of child welfare involvement, relationship to the child(ren), or income. They currently serve caregivers in six counties (Ashe, Avery, Mitchell, Watauga, Wilkes, and Yancey). They are sometimes able to serve caregivers outside of the service area, but this is on a case-by-case basis.

A High Country Caregivers staff member completes a phone call to the caregiver within 24 hours of getting a referral and conducts a home visit assessment within 7 days. In the event a caregiver is unwilling to have the staff member come to their home, they will complete the assessment over the phone, but only if the caregiver is willing to have them visit in the future. In-home assessments are scheduled at the caregiver’s convenience and typically take one hour. HCC developed the assessment tool internally, and it includes information on caregiver demographics, finances, home/living environment, family structure, support system, and goals for the future. Additionally, the assessment includes information on the child(ren), including education, health, or behavioral needs. After an in-home assessment is completed, the caregiver is eligible for services through High Country Caregivers, including organized family events and respite care.

Service Population

The program currently serves Ashe, Avery, Mitchell, Watauga, Wilkes, and Yancey counties, which are bordering counties in the northwest region of North Carolina. The counties are largely rural, fall within the Blue Ridge Mountain Range, and cover 2,300 square miles. The program began in 2006 serving Mitchell, Avery, and Watauga counties, with expansion to Wilkes in 2012, Ashe in 2019, and Yancey in 2021. As of 2023, the program is serving 183 kinship families, including over 300 children. The demographics of families served matches the larger community demographics.


Kinship Navigation

A major component of HCC’s program is kinship navigation. Kinship navigation begins immediately after HCC receives a referral. Once the caregiver establishes their needs and goals, the navigator assists with navigating various forms of assistance, such as completing Temporary Assistance for Needy Families applications; the navigator also connects the caregiver to resources in partnership with local community organizations. The navigator checks in with each kinship family by phone at least monthly, though many families receive weekly correspondence in the form of phone calls, emails, or text messages.

Eyes in the Wild

Eyes in the Wild is a nine-month nature adventure program available to children and teens. The program includes four-hour monthly hikes, as well as the chance for an overnight backpacking trip and a two- to three-night camping trip. HCC developed this program to allow children in the area to experience the beauty of their region. The overnight camping trips are led by therapeutic counselors and supported by HCC staff and other vetted volunteers. These trips provide caregivers with respite and youth with outdoor experiences in nature and time to connect with peers who are also being raised by relatives or close family friends.

A group of children on a swing in the woods.
Photo courtesy of High Country Caregivers

Field Trips

Monthly field trips are offered to youth and families, including snow tubing, river tubing, gaming at arcades, canoeing, attending theater productions, and visiting local farms and orchards. These field trips are well-attended, allowing children to experience activities in their area to build a sense of community and belonging.

A kin caregiver and child smile for the camera as they sit together on a bench.
Photo courtesy of High Country Caregivers

The Learning Shack

The Learning Shack is a program for teens to learn marketable skills and financial literacy. The program introduces youth to vocational professions and training opportunities within their communities, in fields such as auto and home repairs, new construction, mining, and various forms of farming. Additionally, kin caregivers, specifically grandparents, teach children in the program marketable skills such as sewing, weaving, pottery, baking, and cooking. This part of the program passes on Appalachian traditions that foster entrepreneurship and self-reliance, while also promoting intergenerational relationships between grandparents and grandchildren. This program meets bi-monthly throughout the year and ends with guided tours of the local community and technical colleges as well as Appalachian State University. Youth participants learn how to budget costs, market, present, and sell what they made during the program. To help make participation in this program accessible, HCC provides transportation and a healthy meal during the group meetings.

Relatives as Parents Program (RAPP)

The Relatives as Parents Program (RAPP) is a support group that meets monthly in each of the six service counties. The caregiver support groups are led by one of the program’s kinship navigators. The staff note that each county support group has a unique feel to it, but they all help caregivers know that they’re “not on an island alone.” To improve accessibility, HCC provides childcare and a meal each month for every support group. Support groups are well-attended, averaging approximately 10 caregivers at each meeting, with 15 children receiving childcare.


The main office of High Country Caregivers is in Boone, North Carolina (Watauga County). They have an additional office under renovation in Burnsville in Yancey County that will provide working space to the recently expanded service area. Five full-time staff run the program: the executive director, the program director, the communications consultant, and two kinship navigators. Additionally, there is one part-time intern who is a student at the local college. This intern is primarily responsible for overseeing childcare during support groups and other events that offer childcare.

One of the program’s kinship navigators is a kin caregiver, and this experience adds a valuable perspective when creating policies and building rapport with caregivers. The staff team is very small, and all are heavily involved in day-to-day program operations, including the executive director and program director. The staff are committed to knowing each of the families they work with and providing individualized services.

Key Partners

High Country Caregivers has a strong group of partners (organizations and individuals) actively engaged in the daily work of the program. The following is not a comprehensive list of partners, but it provides insight into the many community-based programs that support HCC:

  • Appalachian State University Honors College – provides interns to HCC and serves as a potential source of research collaboration.
  • Avery County – County manager plays an active role in staying connected with HCC, working to understand the unique needs of kin caregivers to best represent the community population.
  • Blue Ridge Partnership for Children – provides family referrals and other supports/groups for families with youth under five in Avery, Mitchell, and Yancey Counties
  • Boone Police Department – helps with camping trips and offers a few “Shop with a Cop” Christmas trips.
  • Casting Bread Ministries – provides food for events.
  • First Baptist Church West Jefferson – provides space for monthly RAPP meetings. Also, some caregivers are members of the congregation, so the church can provide an added layer of support. 
  • Grandfather Mountain – donates tickets for youth to attend field trips.
  • Hawk’s Nest Snowtubing – donates tickets for youth to attend field trips.
  • Hunger and Health Coalition – provides fresh food and wraparound services to families.
  • Mitchell County Senior Center – provides support and activities to caregivers.
  • Project Challenge – works with youth who are sentenced to community service.
  • The Children’s Council – provides family referrals and other supports/groups for families with youth under five in Watauga County.
  • The Children’s Playhouse – provides HCC youth membership scholarships as well as educational materials for group meetings and projects.
  • The Departments of Social Services in six counties – primarily provide referrals to the organization.
  • The Reconciliation House – provides time in a commercial kitchen for baking class and donates food for The Learning Shack program.
  • Veteran Support Volunteer – a community member and veteran who connects on a personal level with caregivers and their families.
  • WAMY – provides families with resources like home weatherization and basic repairs.
  • Watauga Opportunities – provides HCC youth with seasonal gift bags.
  • Western Youth Network – provides after-school support and teen mentoring supports.

Community partners noted that their collaboration with HCC works well because the HCC director and staff are responsive to correspondence and follow up when they say they will. A partner noted that HCC does not duplicate services that already exist elsewhere in the community, but rather looks to the robust group of partners to provide services within the community.

Caregiver Engagement

Caregiver engagement is central to the work of HCC. The program was developed to meet the unique needs of the population of the High Country. Staff, partners, and caregivers all noted that the people in this part of Appalachia take pride in self-sufficiency and therefore are largely hesitant to accept help. Within this framework, HCC builds strong relationships with caregivers, then builds programming specific to what they are requesting.

Financially, [caregiving] has been devastating, but the support from HCC has meant everything. They call to check in and see how [my child] is doing.

Kin Caregiver

One example of building specific programming came from a caregiver who inquired about family photos. Based on this request, HCC held an event with a professional photographer that was free for families. The caregivers were able to get family photos taken, then received digital access to have the photos printed.

It makes a difference when someone other than your regular family cares enough to ask about you.

Kin Caregiver

Outreach to Families

Many referrals come directly from the child welfare agency, the Department of Social Services. However, HCC also serves kinship families who are not involved with child welfare and directs their outreach toward this population. When the executive director joined the organization in 2019, he discovered that there were many kin caregivers in the area who had not heard of HCC. Through outreach, they have grown from serving 22 families in 2019 to serving 183 families by the end of 2023.

The primary forms of outreach are through correspondence with school social workers, breakfasts at the Department of Social Services to educate child welfare staff, radio spots, and referrals from ads in the local newspaper. Additionally, members of the Board of Directors are active in the organization and regularly distribute information on the program throughout the community.

The program does not have a designated recruiter but rather operates with the understanding that all staff are responsible for the recruitment of families.

Funding and Sustainability

The program has a variety of funding sources, including individual donors and multiple grants through both private and community foundations. Several of the grants are secured for multiple years, which aids sustainability. The program is working toward approval to bill Medicaid for a licensed clinical social worker to provide clinical services to children and families. Additional revenue comes from holding fundraising events throughout the year. One of their largest fundraisers, “A Night at Chetola,” takes place in the fall at a local resort and includes live music, a dance floor, dinner, and a live auction. Their other large fundraiser is an annual golf tournament sponsored by an HCC board member, and Hall of Fame former Appalachian State football coach, Jerry Moore. Over 300 community members participated in the golf tournament in 2023, providing both funding and visibility for HCC.

The program has multiple sources of in-kind donations through community partners, ranging from turkeys for holiday dinners to food deliveries, school supplies, cribs, diapers, and items for home repairs, such as portable heaters. There are approximately 50 volunteers who are a part of the community support and teach classes for The Learning Shack program, tutor, mentor, help at fundraisers, cook meals for classes, and help with the Christmas Angels program.

Additionally, HCC benefits from the local college, Appalachian State University. The School of Social Work provides interns to the program, and a sorority at the school has designated HCC as their local charity. Each year the sorority organizes Halloween, Christmas, and Easter parties for the youth in kinship families to attend.

Demonstrating Success and Continuous Quality Improvement

HCC collects data in a variety of ways. Most notably, they conduct an annual survey with all caregivers. To encourage participation, all participants are entered to win a $100 gift card. The agency has found this mode of data collection successful, as they had a 98% completion rate on their most recent survey. Additionally, the agency asks caregivers to complete pre-assessment surveys before they receive services and follow-up surveys six months after they begin receiving services.

The kinship navigators, executive director, and program director hold a weekly meeting to review families by county. They conduct an audit to assess services that have been provided to families, the impact of programs and services, and any pending items. All data is tracked confidentially in a tracking system.

HCC has not engaged in a formal evaluation but is in the process of pursuing various avenues for this to occur.

Challenges and Areas for Program Improvement and Growth

HCC staff report that their biggest challenges are securing long-term sustainable funding and billable income through Medicaid. They recently hired a second kinship navigator to work in three counties, which allows them to serve six counties total. However, since this area of North Carolina is rural and the model operates on home visits, the kinship navigators are driving often. They are responsible for covering a large geographic area while still conducting support groups and attending other community functions. HCC’s current plan is to hire a licensed clinical social worker who can provide counseling, facilitate the support groups, and bill these services to Medicaid. Additional staff will aid in allowing staff members to have identified, specialized roles, which will help to sustain the rapid growth that has occurred in the last three years.

Lessons Learned

HCC applied for an Exemplary Program Designation because program staff believe that there are other small programs like theirs that could benefit from their model. The staff reported that the most valuable lesson they’ve learned is that the entire staff needs to be passionate and work outside of normal expectations. The staff also reported the benefits of an active Board in which Board members actively participate in HCC events. There appeared to be genuine passion about the program among all staff members, partners, and kin caregivers. HCC works hard to have strong rapport and individualized relationships with the kin caregivers.

Additional Program Resources

Learn More about the Network’s Exemplary Designation

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

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