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Hoagwood KE, Richards-Rachlin S, Baier M, Vilgorin B, Horwitz SM, Narcisse I, Diedrich N, Cleek A. Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents. Psychiatr Serv 2024; 75:461-469. [PMID: 38268465 PMCID: PMC11099614 DOI: 10.1176/appi.ps.20230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation. METHODS The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers. RESULTS All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability. CONCLUSIONS The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Shira Richards-Rachlin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Meaghan Baier
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Boris Vilgorin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Iriane Narcisse
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Nadege Diedrich
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Andrew Cleek
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
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Chan ACY, Piehler TF. Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:137-154. [PMID: 37837520 PMCID: PMC10830810 DOI: 10.1007/s11121-023-01594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
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.
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Affiliation(s)
- Athena Chung Yin Chan
- Department of Human Development and Family Sciences, Texas Tech University, P.O. Box 41230, Lubbock, TX, 79409, USA.
| | - Timothy F Piehler
- Deparment of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Avenue, Saint Paul, MN, 55108, USA
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Sanders MR. The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions. Clin Child Fam Psychol Rev 2023; 26:880-903. [PMID: 37432507 PMCID: PMC10640495 DOI: 10.1007/s10567-023-00441-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
Triple P is an integrated, multi-level system of evidence-based parenting support designed to promote the well-being of children and families to reduce prevalence rates of social, emotional, and behavioral problems in children and adolescents and to prevent child maltreatment. The system developed gradually over four decades to address the complex needs of parents and children from diverse family, socioeconomic and cultural backgrounds. It blends universal and targeted programs, a focus on developing parental self-regulation capabilities, and adopts a life span perspective with a population health framework. The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention. Seven stages of program development are outlined from initial theory building and development of the core parenting program through to the sustained deployment of the intervention system delivered at scale. The importance of ongoing research and evaluation is highlighted so that different programs within the system evolve and adapt to address the contemporary concerns and priorities of families in diverse cultural contexts. A well-trained workforce is essential to deliver evidence-based programs, in a need-responsive manner that blends both fidelity of delivery and flexibility and is tailored to respond to the needs of individual families and local context. Programs need to be gender-sensitive, culturally informed, and attuned to the local context including relevant policies, resources, cultural factors, funding, workforce availability and their capacity to implement programs.
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Affiliation(s)
- Matthew R Sanders
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD, 4072, Australia.
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Smith GC, Hayslip B. Grandmother and Grandchild Reports of Psychological Difficulties Among Custodial Grandchildren: Whose View Matters and Why is It Important? CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106793. [PMID: 37220553 PMCID: PMC10201918 DOI: 10.1016/j.childyouth.2022.106793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We conducted this first ever study comparing reports of custodial grandchildren's (CG) psychological difficulties obtained jointly from 163 custodial grandmothers (CGM) and their CG between ages 6-12. Internalizing and externalizing difficulties were indicated by whether any of the corresponding scales on the Strengths and Difficulties Questionnaire (SDQ, reported by CGM) or Dominic Interactive (DI, reported by CG) reached the 90th percentile. Internalizing and externalizing difficulties were reported by informant types at rates higher than those typically observed in the general population, with externalizing difficulties being more prevalent among male CG. At the dichotomous level of (dis)agreement, nearly two-thirds of informant pairs showed concordance regarding whether or not they reported the CG at the 90th percentile on either externalizing and internalizing difficulties. When (dis)agreement was further broken into four specific categories (i.e., "neither report", "both report", "CGM only", and "CG only", CGM's use of mental health services, race, depressive and anxiety symptoms, harsh/punitive discipline, and warmth impacted such concordance as did CG's gender, age, and use of mental health services. The overall findings were remarkably similar regardless of which specific SDQ and DI scales were used in the analyses. The present study unearths new ground regarding the extent to which grandchildren's distress is similarly perceived by CG themselves versus their CGMs. Such findings are important to the extent that accurate estimates exist regarding the emotional difficulties CG face and lay the groundwork for timely and efficacious interventions designed to alleviate their distress.
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Tang F, Li K, Rauktis ME, Farmer EMZ, McDaniel S. Stress, Coping, and Quality of Life Among Custodial Grandparents. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:354-367. [PMID: 35860992 DOI: 10.1080/01634372.2022.2103764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
An increasing number of custodial grandparents are raising grandchildren, and intensive childcare is stressful with many negative personal, interpersonal, economic, and health implications. Grandparents' strengths, including resilience, positive caregiving appraisal, and social support should be considered in the face of parenting stress and adversity. Guided by the stress and resilience model, the current study investigated the associations of parenting stress and coping resources with life satisfaction and mental wellness among custodial grandparents (N = 76). Data were collected between December 2020 and April 2021, through collaborations with community-based agencies located in two metropolitan areas, which provide supportive services to custodial grandparents and their families. Findings showed that more parenting stress was associated with less life satisfaction and worse mental health, and that stress management boosted life satisfaction and mental wellness. Grandparents with more informal social support and social service utilization fared better than their counterparts with less social support and no experience of service use. The results of this study suggest that social work interventions should focus on improving stress management to cope with daily and caregiving stressors. Social workers can help with informal social support and formal social services utilization to address caregiving needs among custodial grandparents.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ke Li
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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Infurna FJ, Castro SA, Webster BA, Dolbin-MacNab ML, Smith GC, Max Crowley D, Musil C. The Dynamics of Daily Life in Custodial Grandmothers. J Gerontol B Psychol Sci Soc Sci 2023; 78:456-468. [PMID: 36130180 PMCID: PMC9985322 DOI: 10.1093/geronb/gbac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Guided by a life-course perspective, we examine the nature of daily life among custodial grandmothers (CGM) through documenting daily positive and negative affect, reporting daily negative and positive events, and emotional reactivity/responsiveness to daily negative and positive events. We also examine whether CGM age, adverse childhood experiences (ACEs), and social relationship quality with grandchild are associated with each indicator. METHODS We applied multilevel models to 200 CGM (Mage = 61, SD = 5.66) who were recruited from across the United States and completed a daily survey for 14 consecutive days prior to commencing a randomized clinical trial. RESULTS Older age and reporting fewer ACEs were associated with better overall and less variability in daily well-being. Positive events were reported on 83% of days and negative events were reported on 56% of days. Daily well-being was lower when a negative event was reported and higher when a positive event was reported. Reporting more ACEs was associated with greater exposure to daily negative events and stronger gains in daily well-being when a daily positive event was reported. Older age was associated with lesser declines in daily well-being on days when a negative event was reported. DISCUSSION In accordance with the life-course perspective, our findings illustrate how the timing of being a CGM (age) and the cumulative nature of development (ACEs) affect daily well-being and negative and positive events for CGM. Our discussion focuses on resources to consider when building resilience-focused interventions for promoting the health and well-being of CGM.
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Affiliation(s)
- Frank J Infurna
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Saul A Castro
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Britney A Webster
- School of Lifespan Development and Educational Sciences, Kent State University, Kent, Ohio, USA
| | | | - Gregory C Smith
- School of Lifespan Development and Educational Sciences, Kent State University, Kent, Ohio, USA
| | - D Max Crowley
- Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Carol Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Hayslip B, Maiden RJ. Attitudes toward mental health and mental health care among custodial grandparents. Aging Ment Health 2023; 27:133-146. [PMID: 35037803 DOI: 10.1080/13607863.2021.2024795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Two-hundred thirty-nine grandparents who were raising their grandchildren were surveyed regarding their attitudes toward mental health and mental health care as well as their use of mental health services, each twice over a one-year time frame.Methods: Mental health attitudes were assessed utilizing self-report scales assessing openness to seeking help, biases regarding mental health and mental health professionals, and breadth regarding beliefs about the origins of mental/emotional distress.Results: Findings suggested that grandparent caregivers were generally positive regarding their willingness to seek mental health care, biases regarding mental health professionals, and beliefs about the origins of emotional distress. Factors that predicted mental health attitudes reflected grandparent personal characteristics, aspects of caregiving, and sample demographics. There was a relationship between attitudes toward mental health and the use of mental health-related services, and having sought help was associated with mental health attitudes and emotional distress at both occasions of measurement and over the one-year timeframe. Some modest evidence was found for the role of openness to seeking help in partially mediating relationships between emotional/caregiving-related distress and mental health care use.Conclusion: These findings are important in understanding not only grandparent caregivers' attitudes toward mental health, but also can serve as a basis for enhancing their use of mental health care services.
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Affiliation(s)
- Bert Hayslip
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Robert J Maiden
- Department of Psychology, Alfred University, Alfred, New York, USA
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Xu Y, Wang Y, McCarthy LP, Harrison T, Doherty H. Mental/behavioural health and educational outcomes of grandchildren raised by custodial grandparents: A mixed methods systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2096-2127. [PMID: 35712998 PMCID: PMC10084073 DOI: 10.1111/hsc.13876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/07/2022] [Accepted: 05/28/2022] [Indexed: 05/27/2023]
Abstract
Grandparents caring for grandchildren has increased globally in the past two decades, but we have a limited understanding of its effects on custodial grandchildren's mental/behavioural health and educational outcomes. This mixed methods systematic review aims to synthesise mental/behavioural health and educational outcomes of custodial grandchildren within custodial grandparent-headed families and with comparison to other types of household structure and further examine factors associated with these outcomes. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched ERIC, Family Studies Abstracts, PsycINFO, PubMed, Scopus, Social Work Abstract and SocINDEX in March 2021 and screened 14,515 articles, which resulted in the inclusion of 42 studies, including 33 quantitative, seven qualitative and two mixed methods studies. The quality of included studies was assessed. This review covered 10 countries, yet most studies revealed that grandchildren raised by grandparents had adverse mental/behavioural health and educational outcomes compared to their peers raised by biological parents. This review further identified multi-level factors contributing to custodial grandchildren's adverse outcomes. Methodological limitations and implications for future practice and research were discussed.
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Affiliation(s)
- Yanfeng Xu
- University of South Carolina College of Social WorkColumbiaSouth CarolinaUSA
| | - Yao Wang
- University of Maryland School of Social WorkBaltimoreMarylandUSA
| | | | - Theresa Harrison
- University of South Carolina College of EducationColumbiaSouth CarolinaUSA
| | - Hanna Doherty
- University of South Carolina College of Social WorkColumbiaSouth CarolinaUSA
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Cox C, Hayslip B. Empowerment Training for Grandparent Caregivers: A Pilot Study. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2022. [DOI: 10.1080/15350770.2022.2130492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Carole Cox
- Graduate School of Social Service, Fordham University, New York, USA
| | - Bert Hayslip
- Department of Psychology, University of North Texas, Denton, USA
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10
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Sanders MR, Mazzucchelli TG. Mechanisms of Change in Population-Based Parenting Interventions for Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:277-294. [PMID: 35133932 DOI: 10.1080/15374416.2022.2025598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes. METHOD Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention. RESULTS A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved. CONCLUSIONS Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.
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Affiliation(s)
- Matthew R Sanders
- Parenting and Family Support Centre, The University of Queensland, Brisbane, Australia
| | - Trevor G Mazzucchelli
- Parenting and Family Support Centre, The University of Queensland, Brisbane, Australia.,School of Population Health, Curtin University, Perth, Australia
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Positive Health Behavior Changes in Custodial Grandparents and Grandchildren Following an Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074027. [PMID: 35409709 PMCID: PMC8997696 DOI: 10.3390/ijerph19074027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Custodial grandparents experience greater physical health declines and higher rates of depression than their same-age peers who do not provide care, and grandchildren in grandfamilies often have behavior problems. However, few researchers have explored the impact of self-care education on decreasing these negative outcomes. Our study examined how a self-care and life-skills intervention influenced health behavior change in a sample of grandparents and grandchildren. METHODS Data were collected during eleven focus groups (and two interviews) with 55 grandparents, and one focus group with five grandchildren, at 6 months after the 6-week intervention detailed in this paper. Grandparents ranged in age from 46 to 84 years old (M = 62.19, SD = 8.24). Participating grandchildren ranged in age from 9 to 12 years old. Focus group transcripts were coded for content related to grandparents' and grandchildren's positive behavior changes following the intervention. FINDINGS Grandparents reported taking more time for themselves, reducing negative self-talk, increasing healthy physical choices, and having better communication skills after participating in the intervention. Similarly, grandchildren reported increased confidence in making friends, making good decisions, and getting along with others. Findings suggest that a self-care and life skills program show promise for improving the health and wellness of grandfamilies.
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Smith GC, Hancock GR, Hayslip B. Predictors and moderators of treatment efficacy in reducing custodial grandmothers' psychological distress. Aging Ment Health 2022; 26:250-262. [PMID: 33393377 PMCID: PMC8846565 DOI: 10.1080/13607863.2020.1857688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.
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Affiliation(s)
- Gregory C. Smith
- School of Lifespan Development and Educational Sciences, Kent State University, Kent, OH, USA
| | - Gregory R. Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Bert Hayslip
- Department of Psychology, University of North Texas, Denton, Denton, TX, USA
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Hayslip B, Montoro-Rodriguez J, Ramsey J, Jooste JL. Process-Outcome Relationships and Solution-Based Goal-Setting Interventions With Grandparent Caregivers. Int J Aging Hum Dev 2021; 95:135-165. [PMID: 34866407 DOI: 10.1177/00914150211050878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study examines the impact of change processes on outcomes in a solution-based thinking and goal-setting intervention for grandparents raising their grandchildren. We found that across the 6 program sessions there was stability and/or increases in the salience of hypothesized change processes, i.e., hopefulness about the future, solution-based thinking, positive thoughts about one's grandchild, multiple indicators of decisional personal goal-setting regarding one's own well-being and grandchild relationship quality. Indicators of change processes were for the most part, related to both post-program outcomes as well as to pre-post program outcome difference scores. Regression analyses suggested that change processes in many cases partially mediated pre-post primary program outcome scores. These data suggest that how grandmother caregivers think about themselves and their grandchildren and their approach to setting personal goals are key change processes explaining the impact of a solution-based, goal-setting intervention on them.
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Montoro-Rodriguez J, Hayslip B, Ramsey J, Jooste JL. The Utility of Solution-Oriented Strategies to Support Grandparents Raising Grandchildren. J Aging Health 2021; 33:647-660. [PMID: 33780271 DOI: 10.1177/08982643211004817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The purpose of this article is to evaluate the effectiveness of a psychosocial intervention program to improve the health and social psychological outcomes for grandparents raising grandchildren using the theory of Selection, Optimization, and Compensation (Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). Cambridge University Press. doi:10.1017/CBO9780511665684.003). Methods: Fifty-two grandparents were randomly assigned either to a 6-session solution-oriented goal-setting program or to a waiting list control condition who subsequently received the intervention. Results: Grandparents in the intervention group, in comparison to the waiting list control group, reduced their level of depression, improved their parental efficacy, overall psychosocial adjustment, and increased their ability to choose effective goals. For the most part, findings were replicated in the waiting list control analyses. Discussion: While these findings are consistent with previous studies using psychosocial interventions with parents and grandparent caregivers, they also provide support for strength-based proactive behavioral approaches to improve the quality of life of grandparent caregivers.
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Affiliation(s)
| | - Bert Hayslip
- Department of Psychology, 3404University of North Texas, Denton, TX, USA
| | - Jennifer Ramsey
- Department of Gerontology, 14727University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jane L Jooste
- 41618Lewisville Independent School District, Lewisville, TX, USA
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Novak-Pavlic M, Abdel Malek S, Rosenbaum P, Macedo LG, Di Rezze B. A scoping review of the literature on grandparents of children with disabilities. Disabil Rehabil 2021; 44:3326-3348. [PMID: 33478262 DOI: 10.1080/09638288.2020.1857850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The objectives of this review were to: (a) explore the extent and nature of available research on non-custodial grandparents of children with physical, intellectual, or neurodevelopmental disabilities and (b) descriptively summarize the research findings from those studies. METHODS We followed the five-stage scoping review methodology to identify relevant studies from four databases: Medline, CINAHL, Embase, and PsycINFO. Primary, peer-reviewed studies that explored grandparent-related topics in the context of childhood disability were included. RESULTS Thirty-one studies were identified and analyzed. All of the studies followed non-experimental and qualitative study designs. In the last decade, there has been a growing interest in research on this population (n = 15). Grandparents varied considerably in age, education, employment status, and living arrangements (n = 4680). Grandmothers represented the vast majority of the population (82%). We grouped the grandparent-related findings from the individual reports into four categories: 1. Adjustment to grandchild's disability, 2. Roles, 3. Perceptions, and 4. Experiences. CONCLUSION Grandparents of children with disabilities are a heterogeneous population that experiences unique challenges in their grandparenting role. Future studies on this topic should be oriented toward high-quality, experimental study designs that take into consideration cultural, religious and demographic factors. Grandparents' involvement in healthcare should be encouraged.IMPLICATIONS FOR REHABILITATIONGrandparents of children with developmental disabilities who are not primary caregivers to their grandchild(ren) are significant family members in many families.They face unique challenges in adapting to their grandchild's disability and interacting with professionals regarding their grandchild's disability and functioning.Although there is considerable heterogeneity within this population, most grandparents share the experiences of gradual emotional adjustment to their grandchild's disability, active family involvement, positive perceptions of their family and grandchild's disability and lack of services for them.There are no identified interventions in the research literature that aimed to support grandparents of children with disabilities.
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Affiliation(s)
- Monika Novak-Pavlic
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Sandra Abdel Malek
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Briano Di Rezze
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Wu Q, Zhu Y, Ogbonnaya I, Zhang S, Wu S. Parenting intervention outcomes for kinship caregivers and child: A systematic review. CHILD ABUSE & NEGLECT 2020; 106:104524. [PMID: 32450459 PMCID: PMC7371572 DOI: 10.1016/j.chiabu.2020.104524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/09/2020] [Accepted: 05/03/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Kinship foster caregivers often face serious challenges but lack adequate parenting capacities and resources. The importance of parenting interventions for kinship foster caregivers has been recognized, and researchers have assessed the effect of various parenting interventions on the caregivers and children. However, no systematic review has been conducted to summarize findings related to parenting interventions targeting kinship care. OBJECTIVES This study systematically summarizes the effect of parenting interventions on kinship foster caregivers and their cared for children, and examines the intervention strategies and research methods used in order to provide a context in which to better understand effects of interventions. METHODS From six academic databases, 28 studies were identified for review. A data template was used to extract the following information from each study: intervention targets, research design, settings, intervention description, outcome measures, and main results for each study. RESULTS Various parenting interventions targeting kinship foster care families have been developed to improve parenting capacities and reduce parental stress. Most of the interventions had a positive impact on the outcomes of both caregivers and children, although the assessed outcomes often differed across studies. Parenting interventions improve caregivers' parenting competency, reduce parental stress, and advance child wellbeing. However, some interventions appear less promising in achieving targeted goals. DISCUSSION The findings suggest that promoting evidence-based parenting interventions with a special focus on kinship care is important for child welfare. Future directions for research are also discussed in this study.
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Affiliation(s)
- Qi Wu
- Arizona State University, School of Social Work, United States.
| | - Yiqi Zhu
- Brown School at Washington University in St. Louis, United States
| | | | - Saijun Zhang
- University of Mississippi Department of Social Work, United States
| | - Shiyou Wu
- Arizona State University, School of Social Work, United States
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Smith GC, Hayslip B, Webster BA. Psychological Difficulties among Custodial Grandchildren. CHILDREN AND YOUTH SERVICES REVIEW 2019; 104:104390. [PMID: 32489225 PMCID: PMC7265777 DOI: 10.1016/j.childyouth.2019.104390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although custodial grandchildren (CG) are likely to have more emotional and behavioral problems than children in general, only a handful of studies involving nationally representative data have investigated this important public health issue. The present study is unique in examining informant reports of psychological difficulties and prosocial behavior, obtained via the Strengths and Difficulties Questionnaire (SDQ) parent version, regarding two samples (n = 509 and n = 323) of CG between ages 4-12 and three samples of age peers from the 2004 National Health Interview Survey (NHIS) residing in homes with either no birth parent (n=184), one parent (n = 1,618), or both parents (n = 3,752). A MANCOVA encompassing the main effects of sample type, child gender, and informant's race across six SDQ subscales (with informant age and education, as well as child age controlled) showed all three main effects to be statistically significant (p < .001). Between subjects effects for sample type were significant for all six subscales (p <.001), with a general pattern found whereby the two CG samples had higher difficulty and lower prosocial scores than all three NHIS samples, with corresponding effect sizes falling in the moderate to very large range. Tests of between subjects effects for child gender showed, that regardless of sample type, males typically had higher difficulty scores and lower prosocial scores than those for females. Tests of between subjects effects by informant's race showed only sporadic differences that were independent of sample type. Comparisons of the SDQ banded scores suggested that CG have considerably different cutoff points than do children in other family structures to indicate a likely diagnosis of a serious psychological disorder. We conclude that primary school aged CG are at an especially high risk for both internalizing and externalizing difficulties regardless of children's gender or informant's race.
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Affiliation(s)
- Gregory C Smith
- College of Education Health and Human Service, Kent State University, Kent OHIO 44242, United States of America
| | - Bert Hayslip
- Department of Psychology, University of North Texas, Denton, TX 76203, United States of America
| | - Britney A Webster
- College of Education Health and Human Service, Kent State University, Kent OHIO 44242, United States of America
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Sadruddin AFA, Ponguta LA, Zonderman AL, Wiley KS, Grimshaw A, Panter-Brick C. How do grandparents influence child health and development? A systematic review. Soc Sci Med 2019; 239:112476. [PMID: 31539783 DOI: 10.1016/j.socscimed.2019.112476] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/09/2023]
Abstract
Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development. Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.
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Harnessing the Power of Positive Parenting to Promote Wellbeing of Children, Parents and Communities Over a Lifetime. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence-based parenting support (EBPS) programs derived from social learning theory, cognitive behavioural principles, and developmental theory are among the most successful innovations in the entire field of psychological intervention. EBPS programs have been at the cutting edge of global dissemination efforts to increase community access to evidence-based parenting programs. Despite the widely recognised success of these efforts, existing models of parenting intervention are not a panacea, and much can be done to improved outcomes. Efforts to improve outcomes have included the emergence of a population-based approach to increase reach of intervention. This has included the development of flexible delivery modalities, including online parenting interventions, the incorporation of strategies to enhance cultural relevance and acceptability of programs, and more recently, applications with parents in very low resource settings. Further enhancements of outcomes are likely to be forthcoming as we gain a better understanding of the mechanisms that explain positive intervention effects and non-response to interventions. More cost-effective online professional training models are needed to disseminate and promote the sustained use of EBPS programs. New interventions are required for the most vulnerable parents when parenting concerns are complicated by other problems such as trauma, addictions, relationship conflict, family violence, mental health problems and intergenerational poverty. However, to scale effective programs, Commonwealth and state government policies and funding priorities need to respond to evidence about what works and make sustained investments in the implementation of parenting programs. Possible strategies to enhance the policy impact of intervention research are discussed.
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