Grandfamilies and the Opioid Epidemic: A Systemic Perspective and Future Priorities

Understanding Grandparent Caregiving in Korean and U.S. Culture: An Analysis Using Role Theory

This study explored grandparent caregiving experiences in Korea and the United States. Using a phenomenological approach, semi-structured interviews were conducted with 20 custodial grandparents (10 in Korea, 10 in the United States) to understand their lived experiences. Under the guidance of role theory, the caregivers' experiences were explained by themes of role consensus, role conformity, and role conflict. Despite Korean and U.S. grandparent groups performing a similar role, relative differences were observed, including Korean grandparents with increased role conformity and the U.S. grandparents with increased role conflict. The distinction highlights the importance of understanding grandparent caregiving in cultural contexts and ensuring that interventions are culturally responsive. Regardless of cultural context, the grandparent caregivers disclosed relatively positive experiences of the pandemic, testifying to their resilience. Lastly, critical role supporters were identified at various levels, demonstrating that developing support systems can be a key in empowering grandparent caregivers.

Parental Substance Use Disorder and the Rise in Children Being Raised by Grandparents: Focusing on Children's Needs and Improving Outcomes

The occurrence of children being raised solely by their grandparents has steadily risen in the past decade prompted by parental substance use disorder (SUD) and associated incarceration and death. These families, especially children, are a vulnerable population with unique needs. Nurses should be cognizant of the needs, risk factors, and protective factors often associated with this population. Meanwhile, the literature to date mostly focuses on grandparents. School and pediatric nurses, specifically, are in an advantageous position to help support these families and help foster better child outcomes. The purpose of the current article is to explore the experiences, needs, and resources for supporting children being raised by grandparents due to parental SUD. Best practices for health care professionals, especially nurses, are discussed as well as future directions for research with this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 62(12), 9-16.].

Including Families in a Response to the Unregulated Toxic Drug Crisis: A Call to Action

The unregulated toxic drug crisis continues to be an urgent health issue in North America. Many families of people who use drugs have been significantly impacted by this issue. In addition to the thousands of North Americans who have been bereaved by drug mortality, many families are providing unpaid care to bridge gaps in services while navigating the grief and stress associated with caring for a loved one amidst a heavily politicized and rapidly changing context. Despite the impact on families, few interventions are in place to lessen the burden of the crisis. This commentary presents a call to action to include families of people who use drugs in a public health response to the toxic drug crisis. We emphasize the need for (1) the consideration and involvement of families in all aspects of policy and program decision making, (2) the recognition of families of people who use drugs within national caregiving and bereavement strategies; (3) increased supports and services for families; and (4) additional research and public health monitoring on the impact of the toxic drug crisis on families.

Needs of Grandparents Raising Grandchildren: A Qualitative Study

This study identified custodial grandparents' perception of sources of stress that may affect their health and better understand their needs. Findings from this qualitative study are based on thematic analysis of interviews with 10 custodial grandparents. The following themes emerged: 1) grandparents' stress from perceived lack of readiness to care for grandchildren; 2) need for effective communication between and among family members; 3) sufficiency of financial and legal resources; 4) access to community resources, and 5) raising grandchildren reenergizes and revitalizes grandparents' physical and mental health. These findings provide insight into the stressful aspects of the role of raising grandchildren. Understanding stressors affecting custodial grandparents and their grandchildren will help school nurses, social workers, teachers, school administrators and other professionals collaborate to address their challenges.

Grandmothers as Primary Caregivers for Their Grandchildren in Uganda: Challenges Faced and Potential for a Sustainable Livelihood Intervention

Global drivers of health, such as poverty, climate change, and public health crises, pose significant impact on many vulnerable groups, such as grandmother-caregivers (GMCs). Engaging community partners in this problem could help in understanding salient issues and devising solutions to alleviate the challenges faced by GMCs. The purpose of the current study was to engage community members in rural Uganda in identifying challenges experienced by GMCs and explore the potential for a sustainable livelihood for this population. We used a community-engaged ethnographic methodology for our qualitative study, which was informed by the Sustainable Livelihood Framework. Themes emerged in two domains: GMC Challenges and Potential for Sustainable Livelihoods and Intervention Recommendations. The challenges experienced by GMCs are multifaceted as are the potential solutions. Our findings have the potential to inform community development interventions that support the livelihoods and well-being of GMCs in Uganda and similar settings. [Research in Gerontological Nursing, 17(1), 43-52.].

A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders

The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.

Socioemotional and Behavioral Problems of Grandchildren Raised by Grandparents: The Role of Grandparent-Grandchild Relational Closeness and Conflict

This study examined the associations of grandparent-grandchild relational closeness and conflict with grandchildren's socioemotional and behavioral problems, including emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. We analyzed primary cross-sectional survey data collected from custodial grandparents in the United States using logistic regression models. The results indicated that grandparent-grandchild relational closeness was significantly associated with lower odds of custodial grandchildren having emotional symptoms, conduct problems, peer problems, and abnormal prosocial behaviors, whereas grandparent-grandchild relational conflict was significantly associated with higher odds of emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. Implications for increasing grandparent-grandchild relational closeness and decreasing relational conflicts among grandparent-headed families are discussed, which might improve grandchildren's socioemotional and behavioral well-being.

Implementing a Grandfamily Intervention During the COVID-19 Pandemic: Responses and Adaptations

The COVID-19 pandemic complicated efforts to deliver interventions to marginalized populations at risk of contracting COVID-19. Grandfamilies are one such group. GRANDcares Plus (GC+) is an intervention designed to help grandfamilies build resilience. It was scheduled to launch shortly after the COVID-19 pandemic began and consequently was heavily influenced by the pandemic. This paper discusses responses and adaptations made in implementing GC+ during the pandemic. Primary information sources included facilitators, COVID-19 information outlets, grandfamilies, and the project site coordinator. As a result, adaptations were made to facilitator training, CDC guidelines/recommendations were employed, potential participants needs and concerns were considered, and additional strategies were incorporated to support grandfamilies. This knowledge translational article contributes to social work by providing insights into identifying, managing, and responding to unexpected challenges. Given the increasing occurrences of unanticipated crises, it is crucial to develop and maintain effective tools for sustainable deliveries of services during difficult times.

The Twelve Ds: An Update to Edwards and Benson's Reasons for Non-Parental Caregiving

This qualitative study examined the prevalence of the "Nine Ds," a framework developed by Edwards and Benson for understanding the heterogeneity of reasons for which grandparents assume care of grandchildren (i.e., death, disease, detention, divorce, departure, drugs, desertion, delivery, deployment) in a contemporary sample. Using a nationwide sample of custodial grandparents (N = 322) and foster parents (N = 105), caregivers were asked their reason for assuming care of the grandchild or foster child within their care. The results of the study suggest that the Nine Ds are a useful framework, but accounted for only 21.74% of responses, indicating the Nine Ds fail to capture many of the reasons for assuming care. Three new themes-dollars, duty, and daily grind-were identified using semantic thematic analysis and are applicable to both grandfamilies and foster families. These themes represent different motivations for assuming care and provide insight into the social structures that may act as barriers to family formation. This study provides a foundation for future research examining the impact of assumed care by non-parental attachment figures on the health and well-being of both grandchildren and foster children.

Stepping Up and Stepping In: Exploring the Role of Nurses in Supporting Grandparents Raising Grandchildren

This study focused on the experiences of grandparents raising grandchildren in rural, Prince Edward Island, Canada. Termed grand-families, there are numerous reasons why grandparents must step up and step in to care for their grandchildren. Often these reasons are related to their adult children's struggles with mental illness and substance use disorders. Adopting Clandinin and Connelly's approach to narrative inquiry, we present findings from the conversational interviews conducted with 12 grandparents raising their grandchildren. Interview data were analyzed through the narrative dimensions of time, place, and relationship. Findings are presented as rich narratives which illuminate the evolution and storied experiences of grand-families. Particularly revealing are the challenges grandparents face as they navigate various systems, including health care, that do not acknowledge the uniqueness of their family form. Nurses work with grand-families across varied clinical settings. Grounded within the philosophy of Patient and Family Centered Care and family nursing theory, this article offers recommendations for supportive interventions that nurses can implement when caring for grand-families across clinical settings. This study has the potential to facilitate the development of evidence-based supports and services, which are responsive to the needs, realities, and complexities of grand-families.

The Opioid Crisis and Child Maltreatment Across Counties and Time in the United States, 2007-2017

Rises in opioid mortality coincides with child maltreatment report rises since the early 2000s. This project joins three literatures to consider mechanisms linking the opioid epidemic and child maltreatment that include: 1) social disorganization which implicates community-level characteristics such as residential mobility and poverty in deviant behaviors 2) geographic and temporal patterning of opioid mortality and 3) community-level substance use and child maltreatment. I combine data from the American Community Survey (ACS), CDC WONDER, and the National Child Abuse and Neglect Data System (NCANDS) in a county-level analysis using fixed effects. I test the relationships between opioid mortality, poverty, residential mobility, and child maltreatment. Regression analyses show a positive association between opioid mortality and child maltreatment with variation across time. They also suggest that opioid mortality has a stronger association with child maltreatment in high poverty counties, and that counties with higher levels of residential mobility have a negative association between opioid mortality and child maltreatment for lower mortality levels. The findings imply that decreasing poverty, opioid mortality, and increasing residential mobility opportunity may decrease child maltreatment.

State-level changes in health insurance coverage and parental substance use-associated foster care entry

For many families whose children are placed in foster care, initial contact with the child welfare system occurs due to interactions with the healthcare system, particularly in the context of the opioid epidemic and increased attention to prenatal drug exposure. In the last decade, many previously uninsured families have gained Medicaid health coverage, which has implications for their access to healthcare services and visibility to mandatory reporters. Using administrative foster care case data from the Adoption and Foster Care Analysis and Reporting System Foster Care Files and health insurance data from the American Community Survey, this study analyzes the associations between state-level health insurance coverage and rates of foster care entry due to parental substance use between 2009 and 2019. State-level fixed effects models revealed that public, but not private, health insurance rates were positively associated with rates of foster care entry due to parental substance use. These results support the hypothesis that health insurance coverage may promote greater contact with mandatory reporters among low-income parents with substance use disorders. Furthermore, this study illustrates how healthcare policy may have unintended consequences for the child welfare system.

Supporting grandchildren's remote instruction during COVID-19: Experiences of custodial grandmothers

While negative impacts of COVID-19-related remote instruction on children continue to emerge, it appears that vulnerable students will disproportionately bear the burden. One such vulnerable population is children being raised by grandparents. The purpose of this mixed methods study was to gain insight into custodial grandmothers' (CGMs) experiences of their grandchildren's remote instruction, as well as individual and contextual factors associated with these experiences. A national sample of 315 CGMs, drawn from two randomized clinical trials, completed an online survey in Spring of 2020. Results of a thematic analysis and supplemental quantitative analyses revealed three themes. First, access to technology and instructional supports were critical to the success of remote instruction, with barriers being difficulties using technology and poor-quality remote instruction. Next, grandchild socioemotional difficulties, and fit with remote instruction, were central to their engagement and success with remote instruction. Finally, CGMs experienced multiple stressors related to managing the demands of remote instruction, work, and family. Challenges associated with remote instruction were related to pre-pandemic difficulties such as grandchild problems and CGM depressive symptoms. Collectively, the results highlight how multiple adversities may have amplified grandchildren's existing vulnerability to negative outcomes. Implications are addressed, including strategies for supporting children raised by grandparents beyond the COVID-19 pandemic.

Ethical Issues in Providing and Promoting Contraception to Women with Opioid Use Disorder

Women with opioid use disorder (OUD) face unique challenges meeting their reproductive goals. Because the rate of unintended pregnancy in this population is almost 80 percent, there has been a push to increase the use of contraceptives among reproductive-aged women with OUD.1 The patient-level ethical issues of such initiatives, however, are often overlooked. This review discusses the ethical issues in two realms: obtaining contraception when it is desired and avoiding contraceptive coercion when contraception is not desired. It is important that access to reproductive education and care be improved to ensure autonomous decision making by women with OUD. It is also necessary to be mindful of the history of oppressive and coercive contraception and sterilization policies in the United States. These policies have left a legacy of mistrust and continue to be manifested in the form of more subtly oppressive policies in contemporary medical practice. Such policies point to the ongoing stigmatization of, and implicit biases held against, women with OUD. Based on these ethical issues, solutions are suggested at the clinical, systemic, and societal levels.