"To grandmother's house we go": health and school adjustment of children raised solely by grandparents

Early and continuing grandparental care and middle school students' educational and mental health outcomes in China

Several recent studies have examined the relationship between grandparents and grandchildren, but few have examined the effects of early and continuing grandparental care on children's development in China. Using data from the China Education Panel Survey, this study examines the effects of early and continuing care, in which grandparents serve as primary caregivers on middle school students' educational (measured by academic performance and cognitive scores) and mental health (depression score) outcomes. Using multilevel analyses and robustness tests, the results show that for urban and rural students, students cared for by their grandparents showed no disadvantages in their educational outcomes. For rural students who received grandparental care in early childhood or adolescence academically outperformed those who received only parental care. Urban and rural students who received only grandparental care in early childhood and adolescence show worse mental health outcomes. These results challenge the prevailing belief that grandparent caregiving can harm grandchildren's school preparation and cognitive abilities.

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.

Does Living with Grandparents Affect Children's and Adolescents' Health? Evidence from China

The level of nutritional health of children and adolescents is an important indicator of social development, and grandparents, as common co-caregivers, may have a considerable impact on the health level of their grandchildren. In this paper, we investigated the effects of grandparents’ coresidence on children’s and adolescents’ nutritional health levels using the CHNS (China Health and Nutrition Survey) database using the PSM (Propensity Score Matching) method’ and identified heterogeneity in the effects of grandparents’ coresidence by PSM grouping in terms of urban and rural areas, age, and the mothers’ education level. It was found that grandparents’ coresidence is beneficial for children’s and adolescents’ health to a certain extent. Overfeeding and spoil that many people worried when grandparents involved in childcare did not happen in our samples. Moreover, grandparents’ coresidence had a more significant effect on the health level of children and adolescents in rural areas at a younger age and with a lower level of maternal education. Government and families should put more effort into equipping caregivers with knowledge on how to raise their grandchildren better.

Living Arrangements and Supplemental Income Programs for Older Adults in Mexico

Living arrangements often reflect important quality-of-life indicators for elderly adults. In particular, increased income can prompt changes in household living arrangements for elderly adults. Using a differences-in-differences approach, we examine whether a supplemental income program in Mexico for adults aged 70 and older influenced household size and composition. We compare outcomes at baseline and at six-month follow-up for elderly adults in the treatment group with those in the control group that did not participate in the program. We find that household size increased by 3% in the treatment group relative to the control group. We also find a statistically significant increase in the number of girls aged 6-11 in the household, likely the granddaughters or great-granddaughters of program recipients. Increases in household size were greatest for adults aged 70-79, couples, households receiving two or more supplemental incomes, and households in the top income tercile. Household size did not increase for households of adults aged 80 and older, singles, households with only one supplemental income recipient, and households not in the top income tercile. These results suggest that when older adults have more income, they use part of this income to house their grandchildren.

The impact of intensive grandchild care on depressive symptoms among older Koreans

OBJECTIVE

The aim of this study was to investigate the impact of intensive grandchild care on depressive symptoms among grandparents.

METHODS

We used data from 2008 to 2012 of the Korea Longitudinal Study of Aging. Using the data from 2008 at baseline, data included 5129 individuals aged 50 years and more without depression with at least one grandchild. A generalized estimating equation was used to investigate the impact of intensive grandchild care on depressive symptoms. Investigated factors included the intensity of grandchild care, measured by hours spent caring for a grandchild per week: (i) none (0 h); (ii) non-intensive grandchild care (1-39 h); and intensive grandchild care (≥40 h). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale.

RESULTS

Among 5128 participants from 2008 to 2012, 3.0% were providing non-intensive grandchildren care, and 1.9% were providing intensive grandchild care. Compared with grandparents providing no grandchild care, those who provided intensive grandchild care experienced reduced depressive symptoms (β = -0.51 [p = 0.007] vs. no childcare). Men (β = -1.22 [p = 0.012] vs. no childcare) providing intensive grandchild care experienced a greater reduction in depressive symptoms compared with women (β = -0.44 [p = 0.029] vs. no childcare) providing grandchild care. Grandparents who were receiving financial support from adult children were more likely to experience reduced depressive symptoms than those not receiving such support.

CONCLUSION

The results of this study reveal that intensive grandchild care is associated with lower depressive symptoms among older adults, particularly men. The findings emphasize the importance of encouraging older adults to participate in grandchild care, regardless of gender. Copyright © 2016 John Wiley & Sons, Ltd.

Grandparents raising grandchildren: a primer for pediatricians

PURPOSE OF REVIEW

To provide clinicians with a review of key considerations relating to the physical and behavioral well-being of children raised by their grandparents.

RECENT FINDINGS

As the number of children being raised by their grandparents in the United States steadily increases, the needs of these families require greater attention. These children and their custodial grandparents face unique health, social, legal, and financial challenges. Children being raised by their grandparents are at higher risk for developmental and behavioral problems because of prior or current adverse family environments. Moreover, there is evidence that custodial grandparents may experience negative health, social, and financial outcomes that may constrain their ability to provide the best care for their grandchildren.

SUMMARY

Pediatricians should not only be aware of the medical and developmental status of children who are being reared by their grandparents, but also assess the needs, abilities, and potential limitations of these custodial grandparents. In addition to providing useful parenting advice and direct support to custodial grandparents, pediatricians should refer these families as needed to local grandparenting groups, social service agencies, experienced legal counsel, and relevant national organizations for support and guidance.

Rearing Generations: Lakota Grandparents' Commitment to Family and Community

Disproportionately, American Indian grandparents assume the responsibility of raising their grandchildren. Few studies have examined the experiences of American Indian grandparents living on reservations. Utilizing Indigenous Methodologies and exploratory, in-depth interviews with 25 Lakota elders living on the reservation. This study explored the realities of raising grandchildren including: reasons they began caring for their grandchildren, challenges they face, and they reveal the care and concern for the broader community's grandchildren within the cultural and social context of the reservation.

Intergenerational Triads in Skipped-Generation Grandfamilies

The past decades have seen growth in numbers of children raised by grandparents without their parent at home, called skipped-generation grandfamilies. This mixed methods study examined statements made by 459 grandmothers about core family relationships between grandmother and child, grandmother and parent, and parent and child. Families were grouped into intergenerational triad types based on patterns of closeness: all close relationships (triple-bonded), two close relationships (double-bonded), one close relationship (single-bonded), or weak relationships between all three family members (not-bonded). Well-being declined steadily for grandmothers from highest in triple-bonded, to lowest in not-bonded families, reflecting their high stake in all three core relationships. For grandchildren, well-being was low when the child failed to bond firmly to either grandmother or parent. On the other hand, children did well if they were close to their grandmother, even when substance abusing parents were emotionally isolated in the family, suggesting resilient children overcome parental neglect when provided with good grandparent care.

Grandparents Rearing Grandchildren

The past decade has seen a marked increase in the number of grandparents who are rearing their grandchildren. School psychologists and counsellors are increasingly called upon to assist this growing population. This article addresses some of the key issues facing these grandparents: the emotional needs of grandchildren and grandparents, financial support, legal concerns and transitions. Suggestions for intervention strategies for school psychologists and counsellors are offered.

Understanding Grandfamilies: Characteristics of Grandparents, Nonresident Parents, and Children

Using data from the Year 9 Fragile Families and Child Wellbeing Study (N~3,182), we investigated the characteristics grandfamilies (grandparents raising their grandchildren with no parent present, N = 84) and compared them to other key groups, including children's nonresident parents and other economically disadvantaged families with children. Results show that grandparents raising their grandchildren were generally better off in terms of educational attainment, marital status, and economic well-being than the child's parents. Grandparents raising their grandchildren also had very similar characteristics to other disadvantaged mothers. Academic and socioemotional well-being was poorer among children in grandfamilies compared with those living with their mothers, but parenting practices were very similar. These findings suggest that although children in grandfamilies may be at a disadvantage academically and socioemotionally, grandparent caregivers are in many ways similar to other fragile-family mothers. Overall, this study enhances our knowledge of an important, yet understudied family type.

Psychosocial functioning in Dutch foster children: The relationship with child, family, and placement characteristics

Foster care is the preferred alternative for out-of-home care, but not necessarily beneficial for foster children's psychosocial functioning. This dilemma leaves researchers with a challenge to find out more about the factors related to foster children's social and emotional functioning. In a sample of 446 Dutch foster children we examined the extent to which three clusters of characteristics, those akin to the foster child, the foster family, or foster placement, were related to foster children's functioning at the time of research. Multivariate three-step hierarchical regression analyses were performed for three outcome variables: externalizing problems, internalizing problems, and prosocial behavior. We found that all three clusters of foster care characteristics were significantly related to foster children's functioning. Foster placement characteristics, in particular interventions aimed at foster children, explained the largest amount of variance in behavior problems. Children receiving interventions had more externalizing and internalizing problems. A possible explanation is that interventions are indicated for those foster children who are in the highest need of additional support. Prosocial behavior was particularly related to foster family characteristics. The results were mostly in line with international research. Careful screening and monitoring of the social and emotional functioning of foster children may help to identify problems at an early stage. In addition (preventive) support should be offered to those foster children and families who are in need of it.

Health-related quality of life of the rural-China left-behind children or adolescents and influential factors: a cross-sectional study

BACKGROUND

Due to sustained export of labor service, the left-behind children/ adolescents in rural areas of China have become a group that can no longer be neglected. However, even up to this day, little is known about the health-related quality of life (HRQoL) of the left-behind children/adolescents, particularly in Midwest China. This study aims at investigating their living condition and analyzing the influential factors of their HRQoL.

METHODS

A cross-sectional study based on households was conducted and 1363 children or adolescents from rural areas of 6 provinces in China, among whom 608 were left-behind and 755 were non-left-behind, were enrolled in a multistage sampling. HRQoL was revealed using the Pediatric Quality of Life Inventory (PedsQL). Differences in scores were analyzed using rank sum tests, and multivariate analyses were conducted with multiple linear regression.

RESULTS

There was a total of 608 (44.61%) left-behind children or adolescents, and they scored significantly lower in terms of the HRQoL synthesis scores (F = 6.14, P < 0.05), Physical Functioning (H = 33.18, P < 0.05), Emotional Functioning (H = 24.99, P < 0.05) and Social Functioning (H = 12.24, P < 0.05), compared with the non-left-behind. Multiple linear regressions indicated that age and mother's final academic qualification were in positive correlation with the HRQoL of the left-behind children, while mother's longer migrant working time and less frequent visits, and being reared by uncle/aunt etc., were potential risk factors for the left-behind children.

CONCLUSIONS

The HRQoL scores of left-behind children or adolescents were significantly lower than those of their counterparts both in the physical and the psychological domains. Influential factors should be considered when relevant policies are being made and intervening practices are being undertaken in the future, so as to improve the HRQoL of the left-behind children or adolescents.

Family structure and multiple domains of child well-being in the United States: a cross-sectional study

BACKGROUND

We examine the association between family structure and children's health care utilization, barriers to health care access, health, and schooling and cognitive outcomes and assess whether socioeconomic status (SES) accounts for those family structure differences. We advance prior research by focusing on understudied but increasingly common family structures including single father families and five different family structures that include grandparents.

METHODS

Our data on United States children aged birth through 17 (unweighted N = 198,864) come from the 1997-2013 waves of the National Health Interview Survey, a nationally representative, publicly available, household-based sample. We examine 17 outcomes across nine family structures, including married couple, cohabiting couple, single mother, and single father families, with and without grandparents, and skipped-generation families that include children and grandparents but not parents. The SES measures include family income, home ownership, and parents' or grandparents' (depending on who is in the household) employment and education.

RESULTS

Compared to children living with married couples, children in single mother, extended single mother, and cohabiting couple families average poorer outcomes, but children in single father families sometimes average better health outcomes. The presence of grandparents in single parent, cohabiting, or married couple families does not buffer children from adverse outcomes. SES only partially explains family structure disparities in children's well-being.

CONCLUSIONS

All non-married couple family structures are associated with some adverse outcomes among children, but the degree of disadvantage varies across family structures. Efforts to understand and improve child well-being might be most effective if they recognize the increasing diversity in children's living arrangements.

Grandparental help in Indonesia is directed preferentially towards needier descendants: a potential confounder when exploring grandparental influences on child health

A considerable body of evidence has now demonstrated positive correlations between grandparental presence and child health outcomes. It is typically assumed that such correlations exist because grandparental investment in their grandchildren improves child health and wellbeing. However, less is known about how grandparents allocate help to adult children and grandchildren, particularly in lower income contexts. Here we use detailed quantitative data from the longitudinal Indonesia Family Life Survey (data collected in 1993, 1997, 2000, 2007; n = 16,250) to examine grandparental help in a society transitioning both demographically and economically. We test the hypothesis that grandparents direct help preferentially towards those adult children and grandchildren most in need of help. This hypothesis was supported for help provided by married grandparents and single grandmothers, who tended to: provide more help to their adult children when this generation had young children themselves, provide financial help if their adult children were poorer, and provide more household help if their adult daughters worked outside the home. One unexpected result was that help from maternal and paternal grandparents is positively correlated; if one set of grandparents is helping the other set is more likely to help, counter to our predictions. These results provide support for the hypothesis that grandparents preferentially invest in some descendants over others, where married grandparents and single grandmothers tend to invest in those adult children and grandchildren with the most need. Investigating the effect of grandparents on child health outcomes may therefore be confounded by grandparent's preferential investment in needier descendants.

Intergenerational transfer of smoking across three generations and forty-five years

OBJECTIVES

Although many have examined the linkages between smoking behaviors across 2 generations, few have examined these linkages among 3 generations.

METHODS

U.S. population representative data for 3 generations are drawn from the Panel Study of Income Dynamics (PSID) in order to examine whether smoking behaviors are passed down from generation to generation and the magnitude of the influence of smoking behaviors across generations (N = 830).

RESULTS

Results indicate direct linkages between both grandparent (G1) and parent (G2) smoking (OR = 4.53; 95% CI = 2.57-7.97) and parent (G2) and young adult offspring (G3) smoking (OR = 2.91; 95% CI = 1.60-5.31). Although the direct link between grandparent (G1) and grandchildren (G3) was not significant (OR = 2.25; 95% CI = 0.96-5.23, p < .10), mediation analyses reveal that the link between G3 and G1 smoking is significantly mediated by G2 smoking.

CONCLUSIONS

Regardless of generation, parent smoking behavior has a direct influence on offspring smoking behavior. The link between grandparent (G1) and grandchild (G3) smoking is mediated by parent (G2) smoking, suggesting that smoking behavior is passed from one generation to the next generation and in turn to the next generation.

African American adolescent mothers' early caregiving involvement and childrens' behavior and academic performance at age 7

The United States continues to have the highest incidence of adolescent births among industrialized nations. This study used transactional and life span theories of development to examine whether caregiving patterns assessed over the first 24 months postpartum predicted children's behavior and academic achievement at 7 years. Participants included 120 primiparous, urban, low-income, African American adolescent mothers who participated in a randomized controlled trial of home intervention. Group-based trajectories were used to examine the pattern of caregiving involvement over time. Two distinct, consistent trajectories of caregiving involvement were found: maternal and shared. Maternal caregiving involvement over the first 24 months postpartum predicted positive child behavior and academic achievement at 7 years. In keeping with both transactional and life span theories, findings suggest that adoption of the parent role may lead to positive long-term outcomes for children of adolescent mothers.

Antecedents and consequences of caregiving structure on young mothers and their infants

This study describes the multigenerational caregiving structure of infants born to young women, the prenatal predictors of caregiving structure, and the effects of caregiving structure on the health of young mothers and their infants 6 months postpartum. The sample consisted of 784 young mothers involved in a longitudinal study in two U.S. cities. Women were classified into eight caregiving structure groups based on the mother's report of herself as a caregiver and her selection of the baby's father and/or grandparents as caregivers. ANCOVA analyses identified predictors and 6 month postpartum outcomes of caregiving structure. Planned comparisons explored the relationships among caregiving structure groups. A majority of women reported caregiving structures other than herself and the father as caregivers (87.1%). Grandparents were indicated as caregivers by most women (62.2%). Postpartum caregiving groups differed on prenatal social support, self-esteem, attachment avoidance and anxiety, relationship status, and living with the baby's father. While mother's self esteem significantly predicted father involvement, there were no differences on predictors between when the mother and father were caregivers, versus when the mother and grandparents were caregivers. Differences existed between groups on mother and child outcomes, including parenting stress, distress, and child dysfunction. Women reported significantly less parenting stress, child dysfunction, and negative child emotions when she and the father were caregivers, versus when she and grandparents were caregivers. The family system and the intergenerational dynamics within a multigenerational caregiving structure are critical to the health and well-being of both mothers and their children.

Social Factors Associated with History of Sexual Assault Among Ethnically Diverse Adolescents

We examine the association of adolescents' self-reported sexual assault victimization with their living arrangements, parent's education, and plans for college. Participants included 1,634 ethnically-diverse and economically-disadvantaged high school students in southeast Texas. Lifetime history of forced sexual assault was reported by 8.3% of girls and 9% of boys. No association with gender, age, or parent's education was detected. However, adolescents in non-traditional households (living with one parent, grandparents, or other) were more likely to report rape than youth living with both parents. Adolescents who were one race/ethnicity were less likely to report being raped than those in the multiple race category. Sexual assault intervention programs should account for a teenager's living situation; and prevention efforts may benefit from targeting individuals in non-traditional households. The lack of an association with either gender or socio-educational status indicates that all children are at risk and that school-based programs should be broadly targeted.

Adolescent mothers leaving multigenerational households

This study examined how the developmental processes of autonomy and relatedness are related to changes in the residential status of 181 first-time, adolescent, urban, low-income, African American mothers over the first 24 months postpartum. Although adolescent mothers were eager to live independently, few made a clear transition out of the multigenerational household; 56% lived in the household of origin continuously (IN), 21% left and never returned (OUT), and 23% had multiple moves in and out of the household (IN/OUT). Older adolescent maternal age, less supportive adolescent mother-grandmother relations, and high household density were associated with leaving the household of origin. The IN/OUT group had difficulty adopting the roles of adult and parent. Helping adolescent mothers and grandmothers negotiate roles to reduce conflict may promote autonomy and relatedness, allowing mothers to learn parenting skills, qualify for public assistance, and continue their education.

Risk of psychological difficulties among children raised by custodial grandparents

OBJECTIVE

Although custodial grandchildren are believed to be at greater risk of emotional and behavioral problems than children in general, scant research has examined this important public health issue.

METHODS

This study involves data from 733 custodial grandmothers participating in a study funded by the National Institute of Mental Health on custodial grandparenting and 9,878 caregivers from the 2001 National Health Interview Survey (NHIS) who completed the Strengths and Difficulties Questionnaire (SDQ) in reference to target children between ages four and 17. These two data sets were used to determine if custodial grandmothers report greater emotional and behavioral difficulties, as measured by the SDQ, for custodial grandchildren than do caregivers of children from the NHIS normative sample.

RESULTS

Custodial grandchildren fared worse than children from the NHIS sample across all domains measured by the SDQ subscales, regardless of the child's gender and whether reporters were recruited by population-based or convenience sampling methods. Comparisons within the sample of 733 custodial grandmothers showed that higher levels of difficulties were reported when grandmothers were caring for boys, were recruited by convenience versus population-based sampling, and were white. Comparisons of the banded scores computed for each SDQ subscale suggested that custodial grandchildren have different cutoff points than children in the general population for a likely diagnosis of a psychiatric disorder.

CONCLUSIONS

Similar to other children in kinship care arrangements, custodial grandchildren are reported by their caregivers to have higher levels of behavioral and emotional disturbances than children in the overall U.S. population.

Risk of psychological difficulties among children raised by custodial grandparents

OBJECTIVE

Although custodial grandchildren are believed to be at greater risk of emotional and behavioral problems than children in general, scant research has examined this important public health issue.

METHODS

This study involves data from 733 custodial grandmothers participating in a study funded by the National Institute of Mental Health on custodial grandparenting and 9,878 caregivers from the 2001 National Health Interview Survey (NHIS) who completed the Strengths and Difficulties Questionnaire (SDQ) in reference to target children between ages four and 17. These two data sets were used to determine if custodial grandmothers report greater emotional and behavioral difficulties, as measured by the SDQ, for custodial grandchildren than do caregivers of children from the NHIS normative sample.

RESULTS

Custodial grandchildren fared worse than children from the NHIS sample across all domains measured by the SDQ subscales, regardless of the child's gender and whether reporters were recruited by population-based or convenience sampling methods. Comparisons within the sample of 733 custodial grandmothers showed that higher levels of difficulties were reported when grandmothers were caring for boys, were recruited by convenience versus population-based sampling, and were white. Comparisons of the banded scores computed for each SDQ subscale suggested that custodial grandchildren have different cutoff points than children in the general population for a likely diagnosis of a psychiatric disorder.

CONCLUSIONS

Similar to other children in kinship care arrangements, custodial grandchildren are reported by their caregivers to have higher levels of behavioral and emotional disturbances than children in the overall U.S. population.

Grandparents Raising Grandchildren: A Response to a Nutrition and Physical Activity Intervention

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.

African American adolescent mothers and grandmothers: a multigenerational approach to parenting

This study is an adaptation and extension of Apfel and Seitz's (Family Relations, 40(4), 421-429, 1991) models of adolescent parenting and adolescent-grandmother relationships to a sample of 148 African American, first-time adolescent mothers and their 6-month-old infants. The Parental Supplemental model, in which adolescent mothers and grandmothers shared caregiving, described 63% of Apfel and Seitz's (1991) sample and 66% of the current sample. Shared caregiving was not associated with conflict in the adolescent mother-grandmother relationship. Adolescent mothers who had caregiving responsibilities and a supportive adolescent-grandmother relationship also reported competence in their parenting role. Findings provide support for Apfel and Seitz's Parental Apprentice model, in which young mothers gain competence through direct caregiving experience in the context of a supportive relationship.

Grandfathers Raising Grandchildren

<i>Objectives</i>. The purpose of this study was to more fully understand the factors that motivate and influence kinship care provided by African American grandfathers who raise their grandchildren. <br><i>Methods</i>. Data were gathered from a community sample of older men, age 65+, who were responsible for the care of at least one grandchild in a rural community in southeastern North Carolina. Fifty-four percent of the grandfathers were African American men who are the focus of the present analysis. Responses were analyzed using a qualitative content analysis mode and descriptive statistics. <br><i>Results</i>. Five factors (obligation, lack of availability of other caregivers, family tradition, role modeling, care and concern) that influence their decision to assume the parenting role emerged and three areas (lack of resources, feelings of powerlessness, religious beliefs and spirituality) that impact their ability to continue providing care were identified. <br><i>Discussion</i>. Findings indicate that practitioners seeking to understand kinship care and assist grandparents who are raising grandchildren must take into account the hardships these families face due to a lack of concrete services and the implications for mental health. Results affirm the need for special attention to grandfathers who provide kinship care. doi:10.1300/J045v22n03_12.

Canadian First Nations grandparents raising grandchildren: a portrait in resilience

Between 1991 and 2001, there was a 20% increase in the number of Canadian children under 18 years old who were living with their grandparents without a parent present in the home. Recent research revealed that Canadians of First Nations origin, including North American Indians, Métis, and Inuit, were vastly over-represented among grandparents raising grandchildren in skipped generation households (households which include only grandparents and grandchildren). Using custom tabulation data from the 1996 Canadian Census, this article presents a profile of First Nations Canadian grandparents raising grandchildren in skipped generation households. Despite extremely high rates of poverty and disability, one-third of First Nations Canadian skipped generation families were raising two or more grandchildren. In comparison to other grandparent caregivers, First Nations custodial caregivers were more likely to also be caring for a senior (23%) and to spend more than 30 hours a week on childcare duties (46%) and on housework (41%). Implications for policy, practice, and research are discussed.

Grandmothers' diaries: a glimpse at daily lives

Little information exists about the daily lives of women who are grandmothers, and the differences in daily stresses based on caregiving status to grandchildren. This content analysis examines the stresses of 64 grandmothers as grouped by caregiver status (grandmothers raising grandchildren, grandmothers living in multigeneration homes, non-caregivers to grandchildren) as recorded in three-week diaries. The nature of salient issues and stressful interactions differed by caregiver groups. Grandmothers raising grandchildren reported more stresses related to grandchildren's routines, activities, and school progress, more time pressure, and difficult interactions with grandchildren. The diary entries of grandmothers in multigenerational homes reflected their supplemental role in childcare, and sometimes stressful interactions with other family members. Grandmothers with no routine caregiving to grandchildren reported more involvement with those outside the immediate family. Many general concerns about the well-being of the family represent commonalities in grandmothers despite differences in current caregiving roles to grandchildren.

Grandparents Raising Their Grandchildren: A Review of the Literature and Suggestions for Practice

An increasingly prevalent family constellation is a home headed by a grandparent who is raising grandchildren. We explore the state of our knowledge about such grandparents with particular attention to its implications for service providers and researchers. In our review we address several key areas: (a) the costs and benefits of raising a grandchild; (b) the heterogeneity of custodial grandparent caregivers; (c) the critical need for social support among custodial grandparents; (d) parenting practices and attitudes among grandparents raising grandchildren; and (e) helping efforts at multiple levels with custodial grandparents. We also discuss directions for research and practice concerning custodial grandparents.

Health-related quality of life in urban elementary schoolchildren

BACKGROUND

Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL.

OBJECTIVE

To examine children's perceptions of HRQOL in an elementary school-based population of urban children.

METHODS

The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children.

RESULTS

Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below 20,000 dollars per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the " parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score.

CONCLUSIONS

Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.

Psychotherapeutic treatment outcomes in grandparent-raised children

PROBLEM

Few studies have focused on grandparent-raised children with behavioral/ emotional problems. The present study examined the therapeutic progress of this population.

METHODS

Data from this descriptive, correlational study were obtained from records of 207 children who received treatment at a child treatment center. Instruments included the Progress Evaluation Scales (PES) and an investigator-constructed tool.

FINDINGS

Children who had regular paternal contact, were younger when treatment started, and were raised by grandparents with adult partners had significantly more positive change in the PES scores.

CONCLUSIONS

More thorough clinical assessment of these reconfigured families will lead to improved mental health outcomes for children and will enhance clinical records as sources of research data.

Issues of separation and reunification in immigrant Latina youth

Latinos make up 12.5% of the total U.S. population, and the largest source of migration to the United States is from Mexico. The intersection of acculturation and risk for Latino immigrant youth is complex, with recent arrivals being protected in the context of strong family ties. Youth, and particularly young women who have been separated from their parents during migration and later reunited, face particular problems that have not been well studied. This article discusses possible stresses facing reunified families, with implications for nursing practice and suggestions for future research.

Grandma's hands: parental perceptions of the importance of grandparents as secondary caregivers in families of children with disabilities

This study examines parental perceptions of the importance of grandparents as providers of routine care to children with disabilities and the impact of such assistance on parental well-being. Data are drawn from a survey and follow-up interactive interviews. Findings of the survey indicate that: 1) grandparents are a common source of weekly assistance-significantly more common than other relatives or friends and neighbors; 2) where grandparents participate, the number of other sources of support is also higher; and 3) help from grandparents has a positive, while the number of other sources of help has a negative, relationship to parental ability to maintain a positive emotional outlook and to avoid physical exhaustion. Findings of the interactive interviews suggest that: 1) grandparent participation can promote pride and "normalized attitudes" by helping grandparents to get to know the child with a disability on an intimate basis; 2) when grandparents do not participate, parents may feel the need to manage the information given to and the emotional responses experienced by grandparents who have not had a chance to get know and love the child through frequent, direct contact; and 3) parents are very concerned that if grandparents themselves begin to need help due to increased age and disability, they will not ask for it because of fear that parents are already overburdened by the unusual demands of their parenting roles.

Meeting the challenge of raising grandchildren

More grandparents are raising grandchildren than ever before. The predictable problems they experience include a revision of personal goals; learning how growing up has changed since they raised their own children; cooperating with the parent who shares responsibility for child care; monitoring social and academic progress of children; becoming aware of rights and available social services; and arranging periodic relief from the daily demands of their surrogate obligations. Full-time grandparents often rely on support groups for comfort and advice. The advantages and limitations of this approach are examined. Recommendations are made for ways to improve how support groups function so they can achieve their purposes.

Custodial grandparenting: stresses, coping skills, and relationships with grandchildren

This cross-sectional study compared three groups of custodial grandparents, those raising problematic grandchildren, those raising "normal" grandchildren, and noncustodial grandparents to identify the unique challenges and expectations faced by custodial grandparents due to their nontraditional roles while attempting to disentangle grandparental role demands from child-specific problems as sources of distress. Those grandparents raising grandchildren demonstrating neurological, physical, emotional, or behavioral problems exhibited the most distress, the most disruption of roles, and the most deteriorated grandparent-grandchild relationships. Although custodial grandparents raising apparently normal grandchildren demonstrated less distress, less disruption of roles, and less deterioration of the grandparent-grandchild relationship than those grandparents raising grandchildren displaying problems, in these respects, they still demonstrated higher such levels than did traditional grandparents.