Parenting intervention outcomes for kinship caregivers and child: A systematic review

Exploring self-care practices of African American informal kinship caregivers

African American caregivers providing informal kinship care are vulnerable to chronic stress. Research has indicated stress increases individuals' risk for many adverse physical and mental health outcomes, including cardiovascular disease, Alzheimer's disease and depression. Given the adverse outcomes related to stress, identifying mechanisms to help these caregivers lower and manage their stress is critical to their overall health and well-being. This pilot qualitative study aimed to explore the self-care practices of 12 African Americans providing informal kinship care using a phenomenological approach. Three themes emerged: (a) behaviours to manage stress levels, (b) support network reminding caregivers to take care of themselves and (c) prioritizing my own needs. Specifically, our findings indicate that some caregivers have high-stress levels and engage in maladaptive coping behaviours. The children they cared for reminded them to take care of themselves by attending doctors' appointments or getting their nails done. Nevertheless, some caregivers prioritized their needs by participating in positive self-care behaviours, such as listening to jazz and gospel music and exercising. Prevention and intervention programs that focus on improving caregivers' health should consider the role of self-care practices.

Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review

This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.

Risk and Protective Factors for African American Kinship Caregiving: A Scoping Review

Background

African American children are disproportionately placed in kinship care, specifically with kin caregivers who have pressing service needs given their relatively poor physical and mental health, and low economic status. Kinship caregivers often face challenges, however, they also show resilience when raising relative children. Although the literature has examined risk and protective factors that affect kinship caregiving, no scoping review has been conducted to summarize these factors as they relate to African American kinship caregivers.

Objectives

This study aims to summarize the risk and protective factors that affect African American kinship caregiving.

Methods

Twenty-six studies were identified from this scoping review. A data template was used to extract information on data/sample, research methods, and risk and protective factors.

Results

This review found that the risk and protective factors in the identified studies can be summarized into four types: child, caregiver, relationship, and legal, cultural or social issues. Caregiver factors were examined from the perspective of physical and behavioral health, parenting, and resources. The most common risk factors were caregivers' low social economic status or great financial need, and caregivers' physical health. The most common protective factor was caregivers' spirituality or religion.

Discussion

This review helps to better understand the risk and protective factors for African American kinship caregivers. Policies should be informed by African American kinship caregivers' unique qualities to provide useful cultural solutions. Evidence based interventions should be developed and provided to African American kinship caregivers to improve their parenting abilities and to provide them with additional resources and supports. Implications for child welfare research are also presented.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

BACKGROUND

The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years.

METHODS

For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics.

RESULTS

In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes.

CONCLUSIONS

Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020177478.

The association between grandparents as caregivers and overdose mortality in Appalachia and non-Appalachia counties

Objective

To assess the association of drug overdose mortality with grandparents serving as caregivers of children in Appalachia and non-Appalachia in the U.S.

Methods

This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and descriptive, bivariate, and multivariable statistics were applied. Multiple sociodemographic and geographic variables were included: median age of the population, percent of the population that is uninsured, percent of the population that is non-Hispanic white, teen birth rate, percent of high school dropouts, and rurality.

Results

The percent of grandparents as caregivers increased as the overdose mortality rate increased (p < 0.01). For every 1% increase in the overdose mortality rate, the percent of grandparents as caregivers increased by 56% in Appalachian counties compared to 24% in non-Appalachian counties. After adjusting for sociodemographic characteristics, the interaction between overdose mortality and Appalachian vs. non-Appalachian counties was no longer significant (p = 0.3).

Conclusions

Counties with higher overdose mortality rates had greater rates of grandparents as caregivers, with Appalachian counties experiencing greater rates of grandparents as caregivers than non-Appalachian counties. Sociodemographic characteristics that are often more prevalent in Appalachia may be driving the observed differences.

Policy implications

Policies and programs are needed to support grandparents providing caregiving for children impacted by substance use disorders including reform to federal child welfare financing to support children, parents, and grandparent caregivers such as kinship navigation, substance use treatment and prevention services, mental health services and in-home supports.

Scientific Publication Patterns of Systematic Reviews on Psychosocial Interventions Improving Well-being: Bibliometric Analysis

Background

Despite numerous empirical studies and systematic reviews conducted on the effectiveness of interventions improving psychological well-being, there is no holistic overview of published systematic reviews in this field.

Objective

This bibliometric study explored the scientific patterns of the effectiveness of different psychosocial interventions improving well-being among various categories of individuals with mental and physical diseases, to synthesize well-being intervention studies, and to suggest gaps and further studies in this emerging field.

Methods

The bibliometric analysis included identifying the most productive authors, institutions, and countries; most explored fields and subjects of study; most active journals and publishers; and performing citation analysis and analyzing publication trends between 2014 and 2022. We focused on data retrieved from known databases, and the study was conducted with a proven bibliometric approach.

Results

In total, 156 studies were found concerning the research domains and retrieved using LENS software from high-ranking databases (Crossref, Microsoft Academic, PubMed, and Core). These papers were written in English by 100 authors from 24 countries, among which, the leading country was the United Kingdom. Descriptive characteristics of the publications involved an increased number of publications in 2017 (n=35) and 2019 (n=34) and a decreased number in 2021 (n=4). The top 2 leading authors by citation score are James Thomas (3 papers and 260 citations) and Chris Dickens (3 papers and 182 citations). However, the most cited study had 592 citations. BMJ Open (n=6 articles) is the leading journal in the field of medicine; Clinical Psychology Review (n=5), in psychology; and Frontiers in Psychology, in psychological intervention (n=5) and psychology (n=5). The top 2 publishers were Wiley (n=28) and Elsevier (n=25).

Conclusions

This study indicates an overall interest in the declared domains within the last decade. Our findings primarily indicate that psychosocial interventions (PIs) were evaluated as being effective in managing mental and physical problems and enhancing well-being. Cognitive behavioral therapy was assessed as being effective in treating anxiety, psychoeducation in relapse prevention, and gratitude interventions in improving overall health, and the mindfulness approach had a positive impact on decreasing distress and depression. Moreover, all these intervention types resulted in an overall increase in an individuals’ well-being and resilience. Integrating social and cultural factors while considering individual differences increases the efficiency of PIs. Furthermore, PIs were evaluated as being effective in managing symptoms of eating disorders, dementia, and cancer. Our findings could help provide researchers an overview of the publication trends on research domains of focus for further studies, since it shows current findings and potential research needs in these fields, and would also benefit practitioners working on increasing their own and their patients' well-being.

Discrepancies between children's and caregivers' child maltreatment reporting and their associations with child wellbeing

BACKGROUND

Child maltreatment reporting is critical for case investigation and service disposition. However, reporting discrepancies across informants is a challenge for child welfare services.

METHODS

Using data from the Fragile Families and Child Wellbeing Study (n = 3150), the current study examined child-caregiver discrepancies in reporting the frequencies of psychological and physical maltreatment. Multivariate models were used to examine how caregivers' reports, children's reports, and discrepancies between the two were associated with child anxiety, depression, aggression, and delinquency.

RESULTS

A quarter of the children reported psychological maltreatment at a higher (25.7 %) or lower (23.8 %) frequency than their caregivers' report, respectively; 8.4 % and 8.7 % of the children did so in physical maltreatment reports, respectively. Multivariate models showed that children's maltreatment reports were more closely associated with children's anxiety, depression, and delinquency than caregivers' reports, while caregivers' reports were more closely associated with children's aggression. After accounting for caregivers' reporting and other covariates, children who reported more frequent psychological maltreatment than their caregivers' report had a higher level of anxiety, depression, and delinquency (b = 0.17 to 0.25, p < 0.001), and the opposite was true (b = -0.36 to -0.13, p < 0.001). Similarly, children who reported more frequent physical maltreatment than their caregivers' report had a higher level of all negative outcomes (b = 0.04 to 0.44; p = 0.04 to <0.00), and the opposite was true for aggression (b = -0.08, p = 0.004).

CONCLUSIONS

The findings suggest that in addition to other reporting barriers, children and caregivers may perceive maltreatment differently, and such discrepancies are related to children's wellbeing.

Black Kin Caregivers: Acceptability and Cultural Adaptation of the Family Check-Up/Everyday Parenting Program

Black children join kinship care disproportionately and black kin caregivers often face financial, housing, mental health, and parenting challenges when caring for relative children. Few interventions have been developed specifically for kin caregivers, let alone Black kin caregivers. This study evaluated the initial acceptability of an evidence based parenting intervention and worked to culturally adapt it for Black kin caregivers. The intervention was delivered in a family camp format. Feedback from participant interviews were analyzed for this study. Participants felt that overall the intervention was culturally appropriate. However, they also proposed changes to the curriculum, as well as to the process and format of the intervention. This study experienced challenges in terms of participant recruitment and sample size, which was exacerbated by COVID-19-related safety concerns. Future steps regarding recruitment, content, and format are discussed. Implications for child welfare practice, policy, and research are also provided.

Pilot randomized controlled trial of an attachment- and trauma-focused intervention for kinship caregivers

BACKGROUND

Kinship care placements are increasing in many Western countries, however families in kinship care are underserved partly due to the lack of evidence-based interventions addressing their unique needs.

OBJECTIVE

We conducted a pilot randomized controlled trial (RCT) to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia.

PARTICIPANTS AND SETTING

Participants included 26 kinship caregivers (M_age = 55.00 years; 54% grandparents) with youth (M_age = 10.58 years; 38% female), and 19 practitioners from child protection, out-of-home care and other services.

METHOD

Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) or care-as-usual (CAU), and completed assessments at baseline, post-intervention, and 6-month follow-up. Placement changes were evaluated at 6-month follow-up. A subset of practitioners received both training and supervision in implementing Connect-KP, and their videorecorded sessions were coded for fidelity.

RESULTS

Practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change.

CONCLUSIONS

Our findings show promise of Connect-KP as a potentially effective intervention that can be successfully implemented in child welfare services, and provide impetus for a larger-scale RCT.

Material hardship and parenting stress among grandparent kinship providers during the COVID-19 pandemic: The mediating role of grandparents' mental health

BACKGROUND

The COVID-19 pandemic has exposed the vulnerability of many families, including grandparent kinship families, to deal with a health/economic crisis. The fear of COVID-19 plus stay-at-home orders have increased individuals' psychological distress. Moreover, school closures and homeschooling further increased parenting stress among caregivers.

OBJECTIVES

This study examined the relationship between material hardship and parenting stress among grandparent kinship providers, and assessed grandparents' mental health as a potential mediator to this relationship during the COVID-19 pandemic in the United States.

PARTICIPANTS AND SETTING

Grandparent kinship providers (N = 362) that took primary care of their grandchildren participated in a cross-sectional survey via Qualtrics Panels in June 2020 in the United States.

METHODS

Descriptive and bivariate analyses, binary logistic regression, and mediation analyses were conducted using STATA 15.0.

RESULTS

Suffering material hardship was significantly associated with higher odds of experiencing parenting stress among grandparent kinship providers, and grandparents' mental health partially mediated this association.

CONCLUSIONS

Addressing material and mental health needs among grandparent kinship providers is critical to decreasing their parenting stress.