Strengthening Workforce and Health Through FFN Child Care in Western North Carolina

The Western North Carolina Family, Friend, and Neighbor (FFN) research project, a partnership between the  NC Center for Health and Wellness (NCCHW) at UNC Asheville  and Smart Start of Transylvania County, provides critical insight into one frequently overlooked component of our regional infrastructure: home-based child care. Led by NCCHW’s Culture of Results initiative and supported by Dogwood Health Trust, this research centers the voices and experiences of FFN caregivers. These are the individuals who provide care for children in unlicensed settings such as homes.

Why FFN Child Care Matters

FFN care represents one of the most widely used forms of child care, yet it is frequently excluded from policy conversations and funding priorities.

In Western North Carolina (WNC), families often rely on FFN care because it is:

• More affordable

• More flexible (including nontraditional hours)

• More culturally aligned with family preferences

• Frequently the only option when formal systems fall short.

When licensed child care options are limited, unavailable, or unaffordable, families turn to trusted networks—relatives, neighbors, and friends—to fill the gap. This is not just a preference; it is a form of community resilience in the face of constrained resources.

At the same time, FFN providers themselves often operate with limited support, minimal compensation, and little formal recognition. If they are sustaining our communities, they must be supported with the tools, resources, and investments they need to thrive while exploring strategies to navigate the larger concerns of our childcare shortage.

The Child Care Gap in WNC

The FFN research cannot be separated from a broader reality: WNC is experiencing a shortage of licensed child care options.

This shortage has created a ripple effect:

• Families struggle to find available slots

• Costs rise for existing care

• More families rely on FFN providers out of necessity

This is a dual challenge and not an either/or situation.

👉 FFN providers need recognition and support👉 Licensed child care facilities also need sustained investment to expand capacity and remain viable

Regional conversations, including those highlighted by the WNC Health Policy Initiative, emphasize that addressing the child care crisis requires strengthening the entire ecosystem of care.

Child Care as Workforce Infrastructure

FFN providers are often called the “workforce behind the workforce,” enabling parents to participate in the labor market—especially in sectors with nontraditional hours.

This is particularly true for healthcare.

Hospitals, clinics, and long-term care facilities rely on workers who need early morning, overnight, or weekend care. In many cases, FFN caregivers are the only option that aligns with these schedules.

Without them:

• Healthcare staffing pipelines weaken

• Worker retention declines

• Access to care is impacted across the region
  

Implications for Healthcare Workforce Development

Strengthening the healthcare workforce is a key priority in WNC, and the FFN research makes one thing clear:

You cannot build a strong healthcare workforce without solving child care.

Supporting FFN care:

• Expands workforce participation

• Is one strategy to stabilize employment for healthcare workers

• Increases system-wide resilience

At the same time, expanding licensed care options is essential to meeting broader demand and ensuring families have choices.

Income as a Social Determinant of Health

The research also connects directly to another priority area: income and economic stability as a social driver of health.

When child care is inaccessible:

• Parents reduce hours or leave jobs

• Household income drops

• Financial stress increases

• Health outcomes decline

When child care systems are supported, including both FFN and licensed care:

• Families can maintain employment

• Income stabilizes

• Communities experience better health outcomes

Supporting caregivers is not just an economic strategy, it is a public health intervention.

A Path Forward

This Western North Carolina FFN research project makes some recommendations for supporting our FFN’s provider:

• Recognize FFN providers as essential community infrastructure

• Invest in supports for FFN caregivers (training, resources, compensation, public services such as libraries & parks)

• Expand or create FFN networks/resource hubs in communities without them 

• Address the shortage of licensed child care facilities

• Integrate child care into workforce and health policy planning

Most importantly, it calls us to recognize what communities have already built to keep our region going.

To learn more about the broader child care landscape in WNC, including the shortage of licensed care, explore additional resources such as the full report and one-pager developed by the NCCHW for Smart Start of Transylvania County as well as conversations from the WNC Health Policy Initiative, including on their podcast.

Disclaimer

This content was developed by the WNC Health Policy Initiative in consultation with people and organizations with connections to the health of people of Western North Carolina. Individual or organizational opinions, findings, conclusions, or recommendations are those of the relevant author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.