Stacey R. Kolomer, Ph.D.

1
Grandparents Raising Grandchildren Interventions
designed for the Physical, Mental Health, and
Social Consequences

• Stacey R. Kolomer, Ph.D.
• Assistant Professor, School of Social Work,
  University of Georgia
• Nancy P. Kropf, Ph.D.
• Associate Vice President for Instruction,
  University of Georgia

2
Grandparent Caregivers

• Estimates identify that one in ten grandparents
  will take on the role of primary caretaker to a
  grandchild for at least six months before the
  child is age 18
• Most caregiving grandparents are grandmothers
• Between 5-6 million children live in grandparent
  headed-households (Generations United, 2003)

3
Description of Caregiving Grandparents

• oppressed/poor
• women
• live in inner cities
• less than high school education
• disproportionate number are African American in
  comparison to their overall population in the
  United States
• at higher risk for depression than other women in
  same age cohort
• at higher risk for physical illness and
  impairments than other women in same age cohort

4
Reasons for Grandparent Caregiving

• substance abuse,
• child abuse and/or neglect,
• divorce,
• death,
• mental illness,
• homelessness,
• HIV/AIDS,
• teenage motherhood,
• incarceration,
• abandonment,
• and unemployment/employment out of area/military
• poverty

5
Common Problems for Grandparent Families

• Depression
• Physical Strain
• IDDM
• HTN
• Heart conditions
• Anxiety
• Isolation
• Restriction of leisure and
• Conflicts with other family members

• Sleep disorders
• Problems with appetite
• Psycho-somatic difficulties
• Increase in medication use
• Increase in physician visits/hospitalizations

6
Interventions

• Education/Support Group/Case management model for
  Grandparents raising children with Developmental
  Disabilities
• Support groups for children living with
  grandparents
• Multidisciplinary approach to case management for
  Rural Grandparent Families
• Lets Talk support group

7
Grandparents of Children with Developmental
Disabilities

• Experience of Grandparents
• caring for child with a developmental disability
  can be a lifelong responsibility
• not aware of and/or do not understand
  grandchilds disability
• unaware of services and resources that they are
  entitled to
• not sure who to contact for assistance
• lacking formal and informal support.

8
Intervention

• Three local service providers (NYC)
• Case management
• Benefits counseling
• Education
• Housing
• Respite
• Summer camp
• Support Groups
• Emotional support
• Education
• This Project was funded by a grant from the
  Joseph P. Kennedy Jr. Foundation.

9
Support Group Curriculum

• Developmental Delays Disabilities
• Getting Services
• Your Grandchilds Education
• The Teen Years
• OMRDD Services
• Skills for Caring

• Helping a child with a disability
• Problem Behaviors
• Custody and Guardianship
• Your Grandchilds Parents
• Planning for the future

In addition, each session included a segment of
Taking Care of the Caregivers
10
Survey of Grandmother Caregivers (n97)

• Gender
• Male 6
• Female 94
• Race
• African American 79
• Caucasian 6
• Latino 12
• Native American 2
• Other 1
• Religion
• Catholic 15
• Protestant 85

11
Survey of Grandmother Caregivers (n97) continued

• Marital Status
• Married/Live in 36
• Divorced/Separated 24
• Widowed 29
• Length of Caregiving (Mingt1 yr Max 35yrs)
• Mean 7 years SD 5.35
• Number of Children Caring for (Min1 Max 7)
• Mean 1.91 SD 1.37
• Working outside of the home 31

12
Measures

• CES-D
• Locus of Control
• Empowerment
• Family
• Community
• Social services

13
Change in Group Over three months

• Baseline After Intervention
  F
• M SD M SD
  Group Time Interaction
• 
  
  
  
  
• CES-D
• Treatment 18.1 11.5 16.6 8.9 0.48 0.37 3.24
• Control 17.0 10.3 20.3 9.9
• Mastery
• Treatment 20.2 2.8 22.4 2.9 0.16 2.11 8.51
• Control 21.9 3.4 21.1 3.3
• 
  
  
  
  
• plt.05

14
Change in Control Group Grandparents after
participation in Support Group

• Baseline After Intervention
  F
• M SD M SD
  Group Time Interaction
• 
  
  
  
  
• CES-D
• Treatment 18.1 11.5 16.6 8.9 0.24 8.52
  3.85
• Control 20.3 9.9 12.6 10.3
• Mastery
• Treatment 20.2 2.8 22.4 2.9 2.09 21.550.00
• Control 21.1 3.3 23.4 3.3
• 
  
  
  
  
• plt.05
• plt.01
• plt.001

15

• Living with Grandparent Caregivers Children
  share their experiences in a school-based support
  group

16
Methods

• Sample
• Seven children ages 7-10 referred by principal of
  NYC elementary school
• Children were assessed by researcher for
  appropriateness of participating in the group
• Six children, 2 girls and four boys invited to
  participate
• Five children completed both pre and post test
  measures

17
Methods continued

• Measures
• Pre and Post test
• Attitude towards grandparent scale
• 11 item scale with responses ranging from never
  true to often true
• Minimum score 0, Maximum score 22
• Higher scores indicate more positive attitude
  towards grandparent
• Cronbach alpha value.90 with this sample.

18
Overview of Support Groups for Elementary School
Children Living with Grandparents

• Based on Banana Splits, a support group for
  children whos parents are getting divorced.
• First Session
• Introductions
• Ground rules
• Contracts

19
Overview of Support Groups for Elementary School
Children Living with Grandparents

• Second Session
• Goal To help children realize that although
  some family members live in different homes they
  are still part of the family
• Draw family home and members
• Third Session
• Goal To assist children in identifying feelings
  that have surfaced as result of living in a
  grandparent family
• Design a Grandparent feelings Journal

20
Overview of Support Groups for Elementary School
Children Living with Grandparents continued

• Fourth Session
• Goal To assist children in identifying
  stressful situations in their life
• Design stress meter to identify things that
  cause stress for the child
• Fifth, Sixth, and Seventh Sessions
• Goal- To provide children the opportunity to
  express their creativity and explore issues
  related to living with the grandparents

21
Overview of Support Groups for Elementary School
Children Living with Grandparents continued

• Design newspaper for children living with
  grandparents
• Articles
• Pictures
• Interviews
• Eighth Session -Final session
• Goal To encourage the children to think about
  what they would need to happen to make things
  more positive for everyone living in their house
• Review with the children the material and topics
  covered in the group. Talk about feelings about
  closure of group.

22
Grandchildrens attitudes towards their
Grandparents Pre and Post test scores

• Mean score of Attitudes towards Grandparent
  scale
• Pre test 16
• Post test 15.2

23
(No Transcript)
24
Common Feelings about being a child being raised
by a grandparent

• Concern about the health of their caregiver
• Concern about who will care for them should their
  grandparents no longer be able to
• Mutual Aide sharing their experiences with other
  children who are living with their grandparents

25
Northeast Georgia Project Healthy Grandparents
26
Rural Grandparent Caregivers

• Approximately 10.5 million older adults live in
  rural areas
• It is estimated that approximately 25 of
  grandparent caregivers live in rural areas

27
Issues Grandparents

• Social isolation
• Alienation from social supports
• No natural occurring support network
• Lack of assess to health care for themselves and
  their grandchild(ren)
• Transportation

28
Issues Grandchildren

• Mental functioning
• More problematic behavior than children raised
  with their biological parent
• Feelings of abandonment
• Parental confusion
• Isolation
• Educational issues

29
Issues Grandchildren

• Health functioning
• May have greater health problems such as HIV
  status
• May also be multi-handicapped with
• Emotional
• Mental health
• and Health issues
• May also have more exposure to alcohol and other
  drugs

30
Areas of Need

• Eight areas of need were identified for the
  families
• Basic needs such as housing, transportation
• Financial circumstances
• Legal concerns such as custody, adoption,
  delinquency
• Child behavior/parenting skills
• Physical and mental health needs of both
  grandchild and grandparent
• Educational circumstances
• Social support and leisure activities
• Spiritual/religious life

31
Project Overview

• Northeast Georgia Project Healthy Grandparents is
  a replication site of Georgia State University
  funded through the Promoting Healthy and Stable
  Families Initiative
• Based on a multidisciplinary approach to case
  management. Includes the following disciplines
• Social Work
• Nursing
• Law

32
Casemanagement Model

• Strengths-based
• Goals
• Mobilize a familys strengths
• Marshal resources
• Maximize family functional capacity
• Client is active participant

33
Description of the Families
34
Demographics

• The families were economically poor and had a
  median income range of 10,001 - 15,000 per
  year.
• Eighty-nine percent of the families had income
  equal to or less than 25,000.
• Child abuse or neglect (27.3) and drug addiction
  (21.8) were the two most prevalent reasons for
  residence with grandparent

35
Demographics
36
Instruments

• Brief Symptom Inventory
• Parental Locus of Control
• Child Neglect Inventory
• Hare Self-esteem Index
• Family Resource Scale
• Family Social Support Scale
• Family Empowerment Scale
• Childs Attitude Toward Mother/Father/Grandmother/
  Grandfather
• SF 36 Health Survey
• Child Behavior Checklist

37
Findings

• Pre/Post
• Brief Symptom Inventory
• Sommatization
• T2.27, df53, p.018
• Interpersonal Sensitivity
• T2.94, df44, p.010
• Paranoia
• T2.77, df42, p.008
• Global Severity Index
• T2.7, df42.1, p.009

38
Results

• Family Resource Scale
• T-3.24, df17, p004
• Family Social Services Scale
• T-3.105, df15, p.007

39
Health Issues

• Hypertension
• Diabetes
• High cholesterol
• Fractures
• Obesity
• Smoking or tobacco usage
• Mood disorders

40
Health Issues Grandchildren

• Overweight
• Poor nutrition
• Safety concerns
• Gun safety
• Mood disorders
• Vision and hearing screening

41
Common Issues Between Grandparent Grandchild

• Exercise
• Weight control
• Poor nutritional factors
• Safety concerns
• Diabetes
• Hypertension
• Mood disorders
• Vision and hearing disorders

42
Lets Talk Rationale

• Advantages over current models
• Non place based
• Dialogue driven
• Oral
• Culturally congruent
• Flexible and portable
• Economical

43
Lets Talk Description

• Topics
• Health
• Self care
• Relationships
• Child behavior issues
• Resources
• Legal issues

Let's talk about
44
Lets Talk Evaluation with Individuals

• Sample
• South Georgia/Michigan
• N 31 grandparents
• Intervention
• 8 week 2 tapes/2 wks
• Phone call
• Evaluation
• Pre post

45
Lets Talk Group Intervention

• Visiting Nurses Health Care Services (VHNS)
• Clients are frail custodial grandparents in Metro
  Atlanta
• Support Group Model

46
Participants

• Sample
• N 6
• Description
• Mean Age - 66 yrs.
• (59 88 yrs)
• Race all African Am.
• Grandchildren 7, four male.

47
Lets Talk Instruments

• Health
• Short Health Form 36
• Brief Symptom Inventory
• Parenting
• Parental Locus of Control
• Ways of Coping
• Grandparent Burden/Reward

48
Universal Needs of Grandparent Caregivers

• Respite
• Links to appropriate resources
• services
• information
• Support
• informal
• formal
• Community task forces
• Ability to understand, accept, and meet
  dependency needs of care receivers

49
Discussion

• Additional research focused on the needs and
  concerns of children being raised by their
  grandparents is needed
• Grandchildren in this study shared concerns
  similar to those of grandparent caregivers
• Data collected from a national sample as well as
  larger sample which are demographically
  representative would greatly contribute to the
  literature.
• Interventions that address the psychological
  needs of the whole family would be beneficial.

50
Next Steps

• Practice
• Specific interventions with populations
• HIV/AIDS
• Rural
• Great Grands
• Coalition development what service sector
• Innovative interventions

• Policy
• Legal
• Education
• Physical and Mental Health
• Housing

51
Next Steps

• Research
• Longitudinal and national
• Grandparents
• Grandchildren
• Family life course
• Risk junctures
• Normative development

• Education
• Interdisciplinary
• Intergenerational
• Experiential learning
• Internships
• Service learning