An aunt brings her niece in for a check-up after stepping in during a family crisis. The visit itself is straightforward, but confirming Medicaid coverage, sorting out guardianship, finding behavioral health support, and handling school enrollment are challenges that extend far beyond a single appointment. Healthcare providers can refer the child and their kin to other resources to help address their complex needs, but a referral is not a partnership. A referral doesn’t tell the provider what happens after the child and kinship caregiver leave the office.  

Did they find the support they needed? What was the treatment they received? Partnership and cross-system collaboration between child welfare, healthcare, education, and behavioral health are critical to providing high-quality, holistic care for kinship caregivers and their families.  

That’s where kinship navigator programs come in. Most healthcare organizations know these programs exist, but few have built active partnerships. That difference matters. Ongoing coordination around the same family leads to better outcomes than a one-time handoff. 

When a Kinship Caregiver Enters Your Facility 

Healthcare providers often serve kinship families without realizing it. A grandparent brings a child for a well visit. An uncle coordinates behavioral health care for his nephew. A sibling manages medications. Many of these arrangements happen outside formal child welfare involvement and often go unrecognized. 

The American Academy of Pediatrics encourages providers to identify caregiving relationships during intake and connect families to community resources, including legal services and navigator programs. Recognizing the arrangement is the first step. Broader coordination between Medicaid and child welfare systems can determine whether that recognition leads to the kind of support that stabilizes families. 

The child is not the only one with unmet needs. Kinship caregivers often carry significant emotional burdens, including guilt, grief, and burnout, that usually go unaddressed. Referral pathways that include peer support or caregiver counseling, along with legal and benefits navigation, help meet caregiver needs that can worsen their mental health and lead to placement instability. 

Why a One-Time Referral Isn’t Enough 

A referral treats the kinship navigator program as an off-ramp. Once the caregiver is handed off, the healthcare team’s job is considered done. This approach misses two key elements that a true partnership can address. 

One benefit of the healthcare office is that teams see families repeatedly. Families visit provider offices for well visits, behavioral health follow-ups, and medication renewals, and without two-way communication, the navigator program may not know if a family’s coverage lapses again. The health system often cannot track whether the original issue was resolved. 

Second, holistic care means coordinating legal, financial, and other needs alongside clinical care, not treating them as separate issues after the appointment. Both sides need to communicate, not just hand off a name and number. 

How Healthcare Providers Can Partner with Kinship Navigator Programs 

There is no single template, but effective models usually combine several best practices, with agreements and workflow changes built on what is already in place. 

A formal warm-referral agreement.
A structured referral agreement can outline how referrals are made, how quickly the navigator program will respond, and what information is shared, such as the caregiving relationship, coverage status, and known service needs. This allows referrals to be tracked against clear follow-up expectations. 

Co-located or embedded navigator access.
One approach is to bring kinship navigator staff on-site, even part-time. A few hours a week in a pediatric clinic or a warm phone transfer from a social worker’s desk can make a difference. This works well in high-volume pediatric or behavioral health settings, reducing the time from identifying a need to connecting the caregiver with help. Even a single navigator visiting one clinic weekly can handle a meaningful share of cases without adding new staff. Start with a conversation about volume: how many kinship arrangements the clinic sees each month and what level of presence is needed. 

Two-way information flow, governed by consent protocols.
One often overlooked step is creating a consented pathway for the navigator program to update the health system based on resolved needs. This can help the health system know when coverage is confirmed, guardianship is filed, or a referral is completed. The health system can also alert the navigator program if a family’s engagement with the clinic lapses. This can help ensure the family and child’s health care needs are met, and the kinship navigator program can conduct outreach to facilitate re-engagement.  

Consider the aunt again. Three months later, her niece’s health care provider notices at a follow-up visit that coverage has lapsed again. Without a two-way relationship, the problem must be solved from scratch. With a partnership, the coordinator can flag it directly to the navigator program, which already knows the family and can respond quickly. This can help thinly stretched provider offices focus on gaps only they can address. 

Joint or shared care planning for complex cases.
For families managing multiple needs at once, such as behavioral health, unresolved guardianship, or lapsed coverage, a joint planning conversation between a health care provider’s office and a navigator can clarify responsibilities. This prevents each side from working independently and can help avoid unnecessary duplication or conflicting guidance. 

This is where trauma-informed care comes to life. Many children in kinship placements have experienced disrupted attachments, and kinship caregivers often step in with little preparation. A joint care plan can connect families with trauma-informed behavioral health resources and peer support for caregivers. Many navigator programs offer caregiver support groups for this reason. 

Starting the Conversation 

Building this kind of partnership starts with a few key questions, best answered in a direct conversation with your state’s kinship navigator programs. The Grandfamilies & Kinship Support Network maintains a state-by-state list to help identify the right program to contact. 

• What does their current referral process look like, and where are the gaps between what they need from healthcare and what we send them today? 

• Is there appetite, on both sides, for a consented information-sharing arrangement rather than a one-directional handoff? 

• Are there natural points of co-location or embedded access, given our patient volume? 

• What would either side consider a reasonable way to know if the partnership is working? 

The Difference Partnership Makes 

Kinship caregivers do not need healthcare systems that simply know navigator programs exist. They need a system where their appointments connect them, with minimal effort, to the legal, financial, and behavioral health support they may not know how to access. This includes support for them, not just the children they care for.  

That is the difference between awareness and partnership. Awareness produces a resource list. Partnerships can create a system that provides early support for families, preventing them from falling into crisis.

The Sellers Dorsey Child and Family Well-Being Team offers comprehensive consulting services for providers, health systems, and state agencies. From growth strategy and business development to building relationships with plans and key stakeholders, our experts have deep knowledge rooted in personal experience.