Evidence in Action

A quarterly research brief from the Center on Trauma and Children

Volume 2, Issue 2
April 2014 

The Center on Trauma and Children (CTAC) is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

Visit our website:
www.uky.edu/CTAC

 

  

 

 

 

 

Grandparents as Parents: Investigating the Health and Well-Being of Trauma-Exposed Families

 

This edition of Evidence in Action provides a brief summary of a recent study conducted by CTAC regarding the experiences of grandparents raising their grandchildren. A complete report of this study can be accessed on our web site at UK CTAC GAP Report. 

 

 Purposes of the Study

 

  • Using a trauma framework, explore the factors contributing to caregiver stress and poor child and caregiving outcomes in custodial grandparents
  • Identify service needs, and barriers to effective service delivery
  • Investigate subgroup differences so services can be tailored accordingly

 

Methods

A sample of 297 grandparents from the state's Caregiver Program for Grandparents Raising Grandchildren and related kinship care network events, such as local support group meetings and two regional conferences for grandparents raising grandchildren, was recruited. All participants were given the opportunity to complete the survey either in written form, online through Survey Monkey or via live interview.

 

 Kentucky Counties Represented in the Sample

   

Study participants were offered a $10 incentive for each completed interview or survey, which was estimated to take approximately 45 minutes to complete. All participation was voluntary and it was communicated to the participants that there were no penalties associated with refusal to complete the survey. All protocols were approved by the University of Kentucky Internal Review Board prior to initiation of the study.

 

 

Questionnaire

 

A 95 item questionnaire was used to guide data collection that included several standardized measures:

  • Parenting Stress Scale (Berry & Jones, 1995)
  • Oslo Social Support Scale (Dalgard, et al., 2006)
  • Child Parent Relationship Scale (Pianta, 1992)
  • Pediatric Symptom Checklist (Jellinek et al., 1988)
  • Rand Health Survey (Hays, Sherbourne, & Mazel, 1993)
  • Items from the Center for Epidemiological Studies- Depression Scale (Radloff, 1977)
  • Life-Space Assessment (Peel et al., 2005)
  • General questions about health, access, service needs, etc.

SUMMARY OF FINDINGS

The Children

  • High rates of trauma exposure were found for Kentucky children receiving primary care from a grandparent. Trauma was mostly interpersonal violence, though there is evidence that there is a shortage of trauma-informed care being provided in some areas (Sprang, Craig, & Clark, 2008).
  • Almost half of survey respondents identified caring for a grandchild with more than one trauma exposure, 19% of the sample met the threshold identified by the ACE study as indicating high risk for poor adult outcomes.
  • A third of the grandparents in the study were parenting very young children (5 or under), who have had a caregiving disruption at a critical stage of development. Disruptions in attachment and/or insecure attachment relationships can confound healthy adaptation.
  • Over half of the respondents in Eastern Kentucky were caring for children with special health or mental health needs. This region of the state may be under-resourced to serve these needs.

The Grandparents

  • 37% -57% of the grandparents reported health problems that impact their activities of daily living . Many cited pain as affecting mobility, energy and interactivity with others.
  • Grandparent pain and child mental health issues may be primary issues impacting the child-caregiver relationships and grandparenting stress.
  • Grandparenting stress was within the moderate range. 14% said they were not sure they would assume custody of grandchildren if they had to do it over again.
  • A high percentage of single caregivers suggests the need for supplemental support services will be high.
  • 42% cited unsatisfied financial needs.

The Context

  • These children have had exposure to negligent caregiving, poor supervision, and exposure to disinhibited and impulsive adults (while in biological homes). This impacts current behavior and presents significant caregiving challenges. For example, substance misuse/dependence by adult children is a primary reason for placement in a grandparents home. A third of the cases necessitated child welfare involvement. A quarter of these parents were in jail.
  • The conditions that led to care disqualified the biological parents as adjunctive or supportive caregivers to parenting grandparents.  
  • Findings suggest geographic concerns for Eastern Kentucky grandfamilies. These children were more likely to be in care due to parent incarceration and substance misuse, raising concerns about the availability of traumatic grief services in the area.

 

A Call to Action

   

  • Need to expand trauma-informed care to all areas of the state, especially under-resourced areas of state.
  • Relational interventions for grandparents should be integrated with trauma care and perhaps with services they are already receiving. Faith-based services may be helpful in meeting this need - consider faith based services (53% use faith-based services and 65% attend place of worship weekly).
  • ADHD evident at a rate of 3 to 1- consider overlap with trauma conditions and misdiagnosis. Training of mental health providers on the importance of providing a trauma assessment may lead to diagnostic clarity.
  • Psychoeducation/safety skills training is needed regarding biological parent substance abuse.
  • Results suggest a high need for support and respite care, but less than 15% identified this as a need. The impact of cultural and financial reasons on this area of need should be considered.
  • Some evidence that grief related psycho-education in schools may be effective- may be a vehicle for addressing needs in Eastern Kentucky.
  • Policies are needed that address financial strain experienced by custodial grandparents (i.e. re-instatement of kinship programs or the development or revision of programs that address financial needs specific to this population).
  • Increase the availability of legal aid for grandparents who need assistance keeping children safe from biological parents. Also, the provision of education for grandparents to help raise knowledge of the legal processes involved in custody issues.
  • Health professionals working with grandparents need to pay attention to their access to health care, medication compliance and provide pain management services, especially non-pharmaceutical pain management strategies. 

References

 

Sprang, G., Choi, M., Eslinger, J., & Whitt-Woosley, A. (2014).

     Grandparents as Parents: Investigating the Health and Well-Being

     of Trauma-Exposed Families. Lexington, KY: University of

     Kentucky Center on Trauma and Children.  

  
Funding for this project was made possible via an award from the Eastern Kentucky Health, Education and Welfare Fund