An estimated 2.7 million grandparents serve as surrogate parents to grandchildren in the United States (U.S. Census Bureau, 2017). While this family arrangement is generally considered more desirable for the well-being of the grandchildren than placement with non-relatives in the foster care system, it may be linked to negative consequences for the caregiving grandparent’s well-being (Denby, Testa, Alford, Cross & Brinson, 2017; Whitley & Fuller-Thomson, 2017; Xu & Bright, 2018). Grandparent-headed families tend to be economically disadvantaged and headed by single women of racial-minority status, although they are represented across all socioeconomic and racial sectors (Whitley & Fuller-Thomson, 2017). Parenting “later in life” often exacts its toll on custodial grandparents. Research indicates that grandparents raising grandchildren have a propensity for diminished physical health as well as relatively high levels of psychological distress, including depression, which can interfere with their ability to effectively nurture and support the children in their care (Kelley, Whitley, & Campos, 2013; Musil, et al. 2011; Whitley & Fuller-Thomson, 2017).
Children Raised by Grandparents
Psychologists and other professionals should be alert to the significant traumatic stress most children raised by grandparents have experienced prior to living with grandparents. Substance abuse and other mental health disorders; child maltreatment, including abandonment; incarceration and the death of one or both parents are the major reasons children are in the care of grandparents. Furthermore, many of these children have witnessed family and community violence. Given their histories of adverse experiences, it is not surprising that these children often display significant behavioral difficulties (Kelley, Whitley, & Campos, 2011; Smith & Palmieri, 2007). Because of the traumatic antecedents to living with grandparents, these children should routinely receive behavioral health screenings to determine if trauma-focused cognitive-behavioral therapy or other interventions are indicated. Other interventions may include family-focused therapy and participation in grief counseling related to the death or absence of one or both parents.
In addition to behavioral problems, children raised by grandparents frequently have developmental delays (Kresack, Gallagher, & Kelley, 2014). Because prenatal substance exposure is common in this population and increases the risk for developmental delays, clinicians should pay close attention to histories of prenatal exposure to alcohol and other substances. Even in the absence of a history of prenatal substance exposure, these children are at increased risk for developmental delays due to early childhood neglect; disruptions in attachments, especially involving relationships with birth parents; and chronic toxic stress. Accordingly, children aged 5 years and younger who are children raised by grandparents need developmental screenings with referrals for comprehensive developmental evaluations, as warranted. Early identification of developmental delays allows for timely access to early intervention services for the children and can lead to appropriate education, resources and support for the custodial grandparents.
The vast majority of children raised by grandparents are in informal kinship care, which involves unofficial arrangements among family members; as a result, their families are not entitled to the same benefits and support services as official foster care families. This is of particular concern because custodial grandparents often lack the basic resources needed to raise grandchildren (e.g., adequate housing, clothes, beds, food). The lack of resources is exacerbated when they are thrust into assuming the care of their grandchildren with little or no time to prepare. Psychologists and healthcare providers alert to these stressors can play an important role by providing referrals to social workers who can assist with accessing public benefits such as Temporary Assistance to Needy Families (TANF), and Supplemental Nutrition Assistance Program (SNAP). Local kinship navigator programs can also provide important information on resources available to grandparents raising grandchildren (Lin, 2014). Because many grandparents do not have legal relationships with the children in their care, referrals to legal service agencies are important.
Caregiver well-being
It is also imperative for providers to encourage caregiving grandparents to access health care for themselves. This is particularly important because custodial grandparents tend to ignore their own health needs while attending to the myriad needs of the grandchildren in their care. This self-sacrificing, while admirable, could ultimately be detrimental to the well-being of the grandchildren they are raising. For instance, research findings indicate that poor physical health and increased stress levels in custodial grandparents is associated with increased behavior problems in the grandchildren they are raising (Kelley, et al., 2011). Furthermore, if grandparents become too ill to continue parenting, the grandchildren are likely to enter the foster care system leading to further emotional trauma. Lastly, because grandparents raising grandchildren often experience social isolation, referrals to local support groups for grandparents raising grandchildren are beneficial.
Interventions
A number of intervention models for grandparent-headed families are described in the literature. The most common intervention model involves support groups. These are generally low cost, easy to implement, and considered an effective form of peer support and information sharing. Additional interventions include resourcefulness training and other forms of psychoeducation, as well as multi-modal approaches that include case management by social workers and home visitation by registered nurses. Descriptions of various interventions and their effectiveness can be found in several systematic review articles (see Chan, Chen, Lo, Chen, Kelley & Ip, in press; McLaughlin, Ryder, & Taylor, 2017; Sumo, Wilbur, Julion, Buchholz & Schoeny, 2018). In general, interventions for grandparents raising grandchildren have been shown to be effective in improving their mental and physical health, increasing social support and enhancing access to resources. With effective supports in place, grandparents are in a better position to foster improved outcomes for the traumatized grandchildren in their care.
Generations United’s website provides additional information on custodial grandparents on its websiteopens in new window.
References
Chan, K. L., Chen, M., Lo, K. M. C., Chen, Q., Kelley, S. J., & Ip, P. (in press). The effectiveness of interventions for grandparents raising grandchildren: A meta-analysis. Research on Social Work Practice. doi: 1049731518798470.
Denby, R. W., Testa, M. F., Alford, K. A., Cross, C. L., & Brinson, J. A. (2017). Protective factors as mediators and moderators of risk effects on perceptions of child well-being in kinship care. Child Welfare, 95(4), 111-136.
Kelley, S. J., Whitley, D. M., & Campos, P. E. (2011). Behavior problems in children raised by grandmothers: The role of caregiver distress, family resources, and the home environment. Children and Youth Services Review, 33, 2138-2145.
Kelley, S.J., Whitley, D.M. & Campos, P.E. (2013). Psychological distress in African American grandmothers raising grandchildren: The contribution of child behavior problems, physical health, and family resources. Research in Nursing & Health, 36, 373-385.
Kresak, K., Gallagher, M., & Kelley, S.J. (2014). Grandmothers raising grandchildren with disabilities: Sources of support and family quality of life. Journal of Early Intervention 36, 3-17.
Lin, C. H. (2014). Evaluating services for kinship care families: A systematic review. Children and Youth Services Review, 36, 32-41. McLaughlin, B., Ryder, D., & Taylor, M. F. (2017). Effectiveness of interventions for grandparent caregivers: A systematic review. Marriage & Family Review, 53(6), 509-531.
Musil, C. M., Gordon, N. L., Warner, C. B., Zauszniewski, J. A., Standing, T., & Wykle, M. (2011). Grandmothers and caregiving to grandchildren: Continuity, change, and outcomes over 24 months. The Gerontologist, 51, 86-100.
Smith, G. C., & Palmieri, P. A. (2007). Risk for psychological difficulties in children raised by custodial grandparents. Psychiatric Services, 58, 1303–1310. https://doi.org/10.1176/ps.2007.58.10.1303
Sumo, J. N., Wilbur, J., Julion, W., Buchholz, S., & Schoeny, M. (2018). Interventions to improve grandparent caregivers’ mental and physical health: An integrative review. Western Journal of Nursing Research, 40(8), 1236-1264.
U.S. Census Bureau. (2017). American community survey, 1-year estimates. Washington, DC: U.S. Census Bureau.
Whitley, D. M., & Fuller-Thomson, E. (2017). African–American solo grandparents raising grandchildren: A representative profile of their health status. Journal of Community Health, 42(2), 312-323. doi: 0.1007/s10900-016-0257-8
Xu, Y., & Bright, C. L. (2018). Children's mental health and its predictors in kinship and non-kinship foster care: A systematic review. Children and Youth Services Review, 89, 243-246. doi:10.1016/j.childyouth.2018.05.001