Blackburn J.A., Dulmus C.N. (Editors). Handbook of gerontology: evidence-based approaches to theory, practice, and policy

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many younger, formerly working grandmothers who had to quit their jobs and

leave behind valued work-based social ties to care for their grandchildren aban-

doned by crack-cocaine-addicted parents (Minkler & Roe, 1993). Thus, available

research indicates that although grandparent caregivers may experience rewards

from the care-giving role, there are measurable costs in terms of poorer health, in-

creased levels of depressive symptoms, and growing social isolation.

ACTORS

FFECTING THE

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AREGIVERS

Although grandparent caregivers overall experience heightened levels of physical

and psychological distress and increased social isolation, there is considerable in-

dividual heterogeneity. For some grandparents caregiving takes a significant toll

on their well-being; others are able to maintain their physical and mental health.

In an effort to understand this heterogeneity, researchers have begun to identify

the effect of different challenges on the well-being of grandparent caregivers and

the social and psychological resources that might mitigate these effects.

Given that grandparents’ primary caregiving often occurs in response to a cri-

sis, the difficulties experienced by the children (e.g., an intensification of behav-

ioral or emotional problems) add to the care-giving challenges associated with

assuming a primary care-giving role (Burnette, 2000; Hayslip, Shore, Henderson,

& Lambert, 1998; Janicki et al., 2000). Consistent with the general literature on

caregiving, grandparent primary caregivers face a greater risk of depression

when caring for grandchildren with behavioral or emotional problems (Burnette,

2000; Hayslip et al., 1998). Higher levels of distress with the parenting role was

found when grandparents report their grandchildren had a greater number of

problems (e.g., resisted authority, difficulty learning, and hyperactivity), as com-

pared to grandparents who perceived their grandchildren as having fewer diffi-

culties (Emick & Hayslip, 1999). In a longitudinal study, grandparents caring for

grandchildren with behavior problems reported higher levels of parental stress

than those caring for grandchildren without such problems (Hayslip, Emick,

Henderson, & Elias, 2002).

One potential source of stress is the day-to-day demands of caregiving, which

can range from meeting the daily care needs of small children to helping with

school work and providing transportation to and after school events. Although

intuitively one would assume that grandparents who provide the greatest

amount of care would have the poorest outcomes, the available evidence is incon-

clusive. In comparing the psychological distress among 101 grandmothers with

grandchildren age 14 years or younger, Bowers and Myers (1999) found that, at

the bivariate level, full-time caregivers reported higher levels of care-giving bur-

den and parenting stress than part-time caregivers, but the group difference in

parenting stress disappeared in the multivariate context. In a national study of

867 grandmothers who maintained households for their grandchildren, grand-

mothers in skipped-generation households were more likely than those in three-

generation households to report higher levels of care-giving burden, whereas the

two groups were not different in satisfaction with the care-giving role, positive

affect, and negative affect (Pruchno & McKenney, 2000).

Yet Musil and Ahmad (2002) reported that grandmothers providing supple-

mental caregiving were more likely to experience depressive symptoms than pri-

mary caregivers when their age, education, employment, and marital status were

Parenting Grandchildren 407

controlled. Using the two waves of the NSFH (1987–1988 and 1992–1994), Szino-

vacz, DeViney, and Atkinson (1999) reported that grandmothers who became the

sole caregiver of their grandchildren between Time 1 and Time 2 were more likely

to be depressed than those who between Time 1 and Time 2 became caregivers

but shared it with the child’s parents living in the household. However, they

found higher levels of depressive symptoms among the grandmothers who con-

tinuously coresided with grandchildren and the parent at both waves than among

grandparents who continuously lived with the grandchildren alone. Thus, the re-

lationship between the amount of care provided and the well-being of the grand-

parent caregivers is complex and depends on the outcome of interest, whether the

grandparent is the sole caregiver or shares caregiving with the child’s parent, and

whether or not the grandparent has recently transitioned into the role.

A common source of stress for some grandparents is ongoing conflict and ten-

sion in the relationship with the child’s parent (Goodman & Silverstein, 2002).

The literature on kinship care suggests that parents whose children are cared for

by relatives do not simply disappear. Difficulties in the interactions with a grand-

child’s parent who is ill, incarcerated, or addicted were found to be one of the

main sources of long-term stress for grandparent primary caregivers (Barnhill,

1996; Burton, 1992; Minkler, Roe, & Price, 1992). In in-depth interviews with 38

grandparent primary caregivers, Weber and Waldrop (2000) found that the adult

children’s chronic problems (e.g., having been in and out of drug rehabilitation)

generate ongoing tension and conflict among all the family members. They also

found that the adult children’s criminal activities and unexpected life patterns

created fear for the safety of the grandparents and grandchildren. A qualitative

study of 10 grandparent primary caregivers found that given the difficult rela-

tionships with their troubled adult children, the grandparent caregivers often ex-

pressed feelings of personal loss (e.g., loss of their freedom, loss of their child,

loss of their peer group) and feelings of guilt and disappointment about the in-

ability or failure of their own child to parent (Morrow-Kondos, Weber, Cooper, &

Hesser, 1997).

Many grandparents caring for grandchildren do not have legal authority for

the grandchildren (i.e., legal custody, guardianship, or adoption). As a result,

common parental tasks such as enrolling the grandchildren in school, day care,

and sports activities can be difficult and frustrating, as can obtaining routine

medical and dental care. Some grandparents may not be financially able to as-

sume the considerable legal fees to obtain legal custody, and others may not wish

to prove in court that their child is an incompetent parent (Flint & Perez-Porter,

1997; Morrow-Kondos et al., 1997).

Finally, financial problems are the most frequently cited source of stress for

grandparent caregivers. The other stressors faced by care-giving grandparents

are often compounded by significant economic difficulties, particularly among

low-income grandparents (Woodworth, 1996). As noted earlier, the households

headed by single grandmother caregivers have substantively higher poverty

rates than other grandparent-headed family units. It is noteworthy that older

grandparent caregivers who retired or who were not working at the time they as-

sumed care-giving responsibilities often suffer from the financial burdens of in-

creased educational, medical, dental, housing, food, and clothing expenses of

caring for grandchildren (Burton, 1992; Creighton, 1991; Emick & Hayslip, 1999).

Some of these grandparents reported spending their life savings, overspending

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an already insufficient Social Security check, or relying on welfare programs

(Gibson, 1999; Mullen, 1996). For working grandparents, the assumption of care-

giving responsibilities may mean quitting a job, reducing work hours, making

other job-related sacrifices, or paying the substantial costs for day care and

babysitters, which may place their own future economic well-being at risk

(Rodgers & Jones, 1999; Sands & Goldberg-Glen, 1998). Although it is clear that

grandparent caregivers experience financial strain, it is unclear whether their fi-

nancial difficulties result from taking over the care-giving responsibility or from

chronic financial problems prior to assuming care. Szinovacz et al. (1999) exam-

ined the change in family income prior to and after caring for grandchildren and

reported that having grandchildren in the household was not associated with

the change in family income.

Researchers have consistently found a significant relationship between finan-

cial strain and psychological distress among grandparent primary caregivers.

Joslin (2000) documented that high psychological distress, measured by the Brief

Symptoms Inventory, was found among low-income grandparent primary care-

givers of grandchildren orphaned by HIV/AIDS. Data from the 1997 and 1999 Na-

tional Survey of America’s Families documented the importance of poverty status

in predicting depressive symptoms of 1,363 grandmother primary caregivers

(Park, 2004). Elevated depressive symptoms were found among those who were

extremely poor (i.e., below 50% of the federal poverty line [FPL]) and poor (i.e.,

between 50% and 100% of the FPL) when compared to those who were nonpoor

(i.e., above 200% of the FPL). Rodgers-Farmer (1999) assessed the economic strains

endured by 82 care-giving grandmothers by a single item asking about their per-

ception of income sufficiency, and found that those grandmothers who perceived

that their income was insufficient were more likely to be depressed than the

grandmothers who perceived that their income was sufficient. However, poverty

status was not significant in predicting depression among 74 Latino grandparent

primary caregivers (Burnette, 1999a, 1999b, 2000). This may suggest that the ef-

fect of financial strain on psychological distress is moderated by ethnicity.

Among the resources that help mitigate the effects of care-giving demands on

caregiver well-being, many researchers have reported on the beneficial effects of

informal support in meeting the needs of family caregivers (Burnette, 1999b;

Kramer & Lambert, 1999; Li, Seltzer, & Greenberg, 1997; Pruchno, Patrick, & Bu-

rant, 1997). However, only a few researchers have examined the role of social sup-

port with respect to grandparent caregivers. Utilizing data from the 1997 Study

of Intergenerational Linkages II, a national sample consisting of 2,000 individuals

age 18 and older, Giarrusso, Silverstein, and Feng (2000) tested the potential of

confidants to moderate the effect of stress on the self-esteem of 162 grandparents.

They found that the number of people the grandparent caregivers perceived as

confidants moderated the effect of care-giving stress on the grandparent’s self-

esteem. More specifically, the grandparent caregivers who had more individuals

in whom they could confide were better protected from the negative psychologi-

cal effects of stress (i.e., lower self-esteem) when compared with grandparents

who had fewer confidants. However, Landry-Meyer, Gerard, and Guzell (2005)

did not find evidence of the buffering effect of social support on caregiver stress

among 133 grandparent caregivers; however, they did find a positive, direct effect

of informal and formal social support on stress outcomes. Similarly, in a study of

41 grandparent primary caregivers conducted by Kelley (1993), social isolation

Parenting Grandchildren 409

and the restriction of roles were significant predictors of psychological distress

measured by the General Severity Index.

There is well-established evidence that social activity and participation is asso-

ciated with better physical health, lower mortality, and increased psychological

well-being among older adults (Jackson & Antonucci, 1992; Utz, Carr, Nesse, &

Wortman, 2002). Again, however, there is limited information available about the

potential effects of social participation on the psychological well-being of grand-

parent caregivers. Minkler et al. (1997) found that whether or not a care-giving

grandparent socialized at least once a week was not significantly associated with

level of depressive symptoms. In contrast, Szinovacz et al. (1999) found a small ef-

fect of social contacts (measured by church attendance or participation in social

church events) on depressive symptoms among grandmother primary caregivers.

Specifically, grandmother primary caregivers who participated in social events at

church reported lower levels of depressive symptoms than those who did not.

Park’s (2004) study revealed that weekly attendance at religious services was di-

rectly associated with lower levels of depressive symptoms. These two studies

point to the role of religion or spirituality as a resource to grandparents coping

with the challenges of raising grandchildren.

In addition, Park’s (2004) study found evidence of a buffering effect of volun-

teer activities. Care demands were significantly associated with higher levels of

depressive symptoms only for grandmothers with lower levels of volunteer activ-

ities. The social companionship obtained through volunteer activities may de-

crease the grandmother caregivers’ depression by meeting their needs for

affiliation or by helping to divert their thoughts away from worrying about the

problems they face (e.g., caring for grandchildren with disabilities). Moreover, a

greater number of roles and multiple identities occupied by grandmother care-

givers may provide a sense of purpose in life or be a source of self-esteem, which

mayenhancetheirpsychologicalhealth.However,itisworthnotingthatforcer-

taincaregivers,multiplerolesmaybeanadditionalstressor,dependingonthena-

ture of the role. Grandparent caregivers with full-time jobs reported having less

energy to devote to child care (Hayslip et al., 1998). They may not only have work

and grandparent care-giving responsibilities, but also be caring for aging parents

or their own children. With this caveat, the general pattern of research findings

suggests that grandmother primary caregivers directly benefit from a large net-

work of friends and social participation in church and community activities.

With respect to demographic factors, Minkler et al. (1997) found that increased

psychological distress was associated with being female, poorer health, and

younger age. The relationship of sex and health to psychological distress is con-

sistent with the more general literature on the relationship of sex and health to

depressive symptoms. However, the relationship of grandparent’s age to psycho-

logical distress is less expected, as one would assume that age-related changes

would interact with the demands of caring for young children in taking a toll on

grandparent well-being. It remains unclear whether in studying grandparent

caregiving, age may be a proxy for another variable (e.g., caring for grandchildren

of adolescent parents) that might shed light on this unexpected relationship be-

tween caregiver age and well-being.

Race and ethnicity are additional factors that condition the context in which an

individual grandparent caregiver responds to stress (Dilworth-Anderson, Burton,

& Johnson, 1993; Seltzer & Greenberg, 1999). Grandparents in racial and ethnic

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minority groups are more likely to assume and to be accustomed to a parenting

role for their grandchildren, given historical and cultural differences in role ex-

pectations. Compared to Caucasian grandmothers, African American grandmoth-

ers have historically served as family keepers in response to family crisis and

disruptions due to slavery, the parents’ migration to look for better economic op-

portunity, and single parenthood (Burton & Dilworth-Anderson, 1991; Dilworth-

Anderson et al., 1993; Jimenez, 2002). With a strong emphasis on familism,

Hispanic grandmothers are more likely to live in intergenerational households

and to be called on to play a primary care-giving role for grandchildren (C. B. Cox,

Brooks, & Valcarcel, 2000; Goodman & Silverstein, 2002).

Recent studies that compared African American and Caucasian grandmother

primary caregivers found that the two groups of grandmothers were similar to

each other in age, reasons for caregiving, grandchildren’s characteristics, and im-

pact on the grandmothers’ work life, but found differences in marital status, work

status, income, and burden between the groups (Pruchno, 1999; Pruchno &

McKenney, 2002). Specifically, African American grandmother caregivers were

more likely to be employed outside the home and to have received support ser-

vices such as Aid to Families with Dependent Children, Food Stamps, and Medic-

aid than White care-giving grandmothers. Nevertheless, Caucasian grandmothers

were more likely than African Americans to feel tired, isolated, and trapped in

their role (Pruchno, 1999; Pruchno & McKenney, 2002). Likewise, Musil and

Ahmad (2002) found that White grandmother caregivers were more likely than

their non-White counterparts to be depressed.

However, other researchers found no difference in depressive symptoms

among care-giving grandparents by race and ethnicity (Szinovacz et al., 1999),

and still others found elevated rates of distress in African American caregivers. A

recent study using data from the 1999 NSAF found that in skipped-generation

families, African American grandmothers were more likely than Caucasian

grandmothers to report feelings of psychological distress (Mills, Gomez-Smith, &

De Leon, 2005). However, Goodman and Silverstein (2002) found that African

American grandmothers in three-generation households had poorer mental

health than their counterparts in skipped-generation households, whereas the

levels of psychological health were not different between those in skipped- and

those in three-generation households in the Caucasian or Latino grandmother

groups. Burnette (1999a) reported in her study of 74 Latino grandparents that

about half of the grandparents had symptoms of mild depression based on the

Geriatric Depression Scale.

Additional characteristics associated with grandmothers’ stress are educa-

tional attainment and marital status. There is evidence of higher levels of depres-

sive symptoms in care-giving grandmothers who have lower levels of education

and who are unmarried (Caputo, 2001; Kolomer, McCallion, & Janicki, 2002;

Musil & Ahmad, 2002). Elevated psychological distress among more poorly edu-

cated grandmother caregivers may occur because those with less education have

a more limited ability to access the necessary help and information to care for a

grandchild.

Grandmother caregivers who are married or have a partner may report less

stress because married individuals have greater financial resources as well as

benefit from the emotional support of a spouse. However, Pruchno and McKenney

(2000) found higher levels of care-giving burden among grandmother caregivers

Parenting Grandchildren 411

who were married in skipped-generation households, possibly because the spouse

might be disabled, which would place an additional burden on the caregiver.

Although increasing attention in the literature has been given to work-family

conflict among caregivers (e.g., Jenkins, 1997; Marks, 1998; Moen, Robinson, &

Fields, 1994), little research is available on the relationship between employment

and caregiving in the grandparent caregiver population. One exception is a study

by Sands and Goldberg-Glen (1998), which examined the effect of employment

status on the psychological health of a convenient sample of 123 full-time care-

giving grandmothers. The researchers found that 38% of the grandmothers were

employed at the time of the interview, although 67% reported that they were em-

ployed prior to the onset of care-giving responsibility. Results from the multivari-

ate analysis revealed that employed grandmother caregivers were more likely to

have better mental health than those who were unemployed. This finding is con-

sistent with the larger literature suggesting that employed women caregivers are

more likely to report higher self-esteem and life satisfaction than those who are

unemployed (Moen et al., 1994).

Several conclusions can be reached from this review of the literature about

the factors affecting the physical and mental health of caregivers and the psy-

chosocial resources that buffer stress among grandparent caregivers. First,

grandparent caregivers face a greater risk of distress when they are caring for

children with elevated levels of behavioral or emotional problems. Second,

grandparent caregiving takes it greatest toll on women, in poor health, with

fewer years of education, and who take on the care-giving role at a younger age.

Third, consistent with the larger care-giving literature, informal social support

and employment play a protective role in maintaining the health of grandparent

caregivers. Whether the protective function of work is due to the increased fi-

nancial resources that employed grandparents have at their disposable or due to

the beneficial effects of multiple roles is unknown but is an important area for

future research.

Further, this discussion of the context of caregiving is by necessity an over-

simplification of a very complex process. It is often difficult to disentangle

factors that increase the risk that one will assume the role of caring for grand-

children from the outcomes of taking on the care-giving role. For example, some

coresident grandparents began caring for grandchildren because of parental fi-

nancial problems (Woodworth, 1996). These grandparents then suffer further

financial problems due to the cost of caring for grandchildren (Casper &

Bryson, 1998; Pinson-Millburn et al., 1996), which may amplify psychological

distress that was present prior to taking on the grandparent role. Hence, preex-

isting circumstances that may require grandparents to take on the care-giving

role may in turn intensify when the care-giving role is assumed and result in an

elevated level of distress that was already present, albeit at a lower level, prior to

assuming the care-giving role.

FEDERAL AND STATE POLICIES THAT AFFECT

GRANDPARENT CAREGIVERS

Grandparent primary caregivers are affected by federal and state policies within

two main realms: public income assistance and child welfare. Major sources of fi-

nancial support for grandparent primary caregivers are cash assistance grants

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through the welfare system’s income assistance program (i.e., Aid to Families with

Dependent Children, or, since 1996, Temporary Assistance for Needy Families

[TANF]) or foster care payments through the child welfare system. An emerging

trend is for states and localities to develop subsidized guardianship and other pro-

grams that address the needs of various types of kinship families who are not in-

volved in traditional foster care or TANF program (Leos-Urbel, Bess, & Geen, 2000).

Special rules apply in TANF if the grandparents share the household with a

parent (whether the parent is a teen parent or an adult) as well as grandchildren

(A. G. Cox & Pebley, 1999). Grandparent caregivers in skipped-generation house-

holds may choose either to exclude themselves from the assistance unit (i.e.,

child-only grant) or to be included as part of the assistance unit (i.e., full grant).

Grandparents’ income and assets are only counted in determining the grandchil-

dren’s eligibility for the grant when grandparents choose to be included. How-

ever, if the parent of the grandchildren is present in the grandparent-headed

households and is over the age of 18, the child’s eligibility criteria for cash assis-

tance are based exclusively on whether that parent is eligible. When the parents

themselves are minor children (i.e., under the age of 18), the TANF regulations re-

quire the teenage parents to live with their parents (in this case, the grandparent

of the newborn) or legal guardian and to be in school or employed as a condition

of the assistance (Minkler et al., 1999). In this case, the grandparents’ financial

resources are not considered to determine the eligibility of the teen parents and

grandchildren. It is possible that grandparents who are employed might need to

leave their jobs to provide care to the grandchildren. If these grandparents cur-

rently receive cash welfare while raising their other children, then becoming the

de facto caregiver of the teenage parents’ children could make it more difficult

for the grandparents to meet the work requirements and possibly cause them to

lose the full grant.

Three provisions of the 1996 welfare reform law that are critical for grandparent

primary caregivers are work requirements, time limits, and varying levels of cash

assistance from individual states. The welfare reform legislation considerably al-

tered the financing and structure of cash aid and other social welfare programs.

Although the federal government imposes some conditions, such as work re-

quirements and time limits, states may now design their own welfare programs.

As a result, the effects of the Personal Responsibility and Work Opportunity Rec-

onciliation Act on grandparent primary caregivers vary from state to state.

State sanction policies might affect grandparent primary caregivers who fails

to comply with work requirements and do not have good-cause exemptions. Sanc-

tions take the form of reducing or eliminating benefits for the family. Formerly, if

an adult fails to meet work requirements, the family grant was reduced by that

adult’s portion. Under TANF rules, the full amount of the family grant could po-

tentially be sanctioned in some states. Therefore, nonexempted grandparent pri-

mary caregivers living in states with full-benefit sanctions must consider

whether their failure to comply with work requirements may result in the loss of

cash assistance. Even in those states with partial benefit sanctions, grandparent

caregivers must evaluate whether receiving child-only grant without work re-

quirements would be more beneficial for their families than receiving full grant

with the potential sanction (Mullen & Einhorn, 2000).

In the ongoing debate about welfare reform, concerns have been expressed

about the potential unintended consequences of the work exemption. It is possi-

Parenting Grandchildren 413

ble that grandparents who are exempted from all the requirements might be pres-

sured to take in grandchildren if the grandchildren’s parents exhaust their time

limits or lose substantial amounts of their benefits due to noncompliance with

work requirements (Minkler et al., 1999). Moreover, concern has been raised that

parents might leave their children with relatives (who might be grandparents) to

avoid the new welfare requirements in order to preserve assistance in the form of

child-only grants (Boots & Geen, 1999). However, there is little empirical evi-

dence supporting these concerns.

The maximum TANF benefit varies dramatically from state to state (American

Association of Retired Persons, 1998). For instance, in January 2000, the monthly

child-only benefits for one grandchild living in the continental United States

ranged from a high of $503 in Vermont to a low of $68 in Texas, with a median rate

of $221 (U.S. House of Representatives, Committee on Ways and Means, 2000). Al-

though some qualified grandparent primary caregivers may seek public assis-

tance, the level of benefits is often insufficient to allow them to reach the official

poverty threshold (Mullen, 2000).

The other source of federally supported payments that can assist grandparent

primary caregivers is the foster care program under Title IV-E of the Social Secu-

rity Act (Karp, 1996). A major difference between foster care and TANF is that

children in foster care are in the state’s legal custody and not the caregiver’s cus-

tody. In addition, foster care imposes stringent requirements, including ongoing

supervision and oversight from the child welfare agency. The rules and regula-

tions regarding eligibility for foster care payments also vary considerably among

states. A grandparent caregiver might be eligible for foster care payments in one

state, whereas in another state a grandparent in the same circumstances might

qualify only for welfare payments (Boots & Geen, 1999).

Some states provide permanency options to kinship caregivers, the majority of

whom are grandparents, for children if the child welfare authorities determine

that reunification with the parent is not feasible. These options also provide finan-

cial support to kinship caregivers, including adoption assistance and subsidized

guardianship (Farrell, Fishman, Laud, & Allen, 2000; Leos-Urbel, Bess, & Geen,

2000). Adoption assistance offers adoptive parents a monthly subsidy, which may

not exceed the foster care payment. Subsidized guardianship programs provide

monthly payments, which are less than or equal to the state foster care payment,

to relatives who become the legal guardians of children in their care.

In summary, due to the lack of uniform regulations from the federal govern-

ment for state kinship care policies, states have greater flexibility in serving kin-

ship caregiver families. This brings about substantial variability in financial

assistance options for grandparent primary caregivers within and across states.

EVIDENCE-BASED INTERVENTIONS FOR

GRANDPARENT CAREGIVERS AND THEIR FAMILIES

Grandparents caring for grandchildren have a wide range of needs. Based on a

random survey of 6,307 Ohio households, of which 10% consisted of a grandpar-

ent providing care to a grandchild, Landry-Meyer (1999) identified six basic

needs for this group of caregivers: health care services for the grandchild, health

care services for the grandparent, recreational and social activities, accessible

and affordable child care, consistent and equitable access to programs and

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services, and the ability to exercise parental authority and help with permanency

planning. Others speak to the need for guidance in managing a child’s behavior

problems, information and education about services and supports available to

grandchildren, and respite care (Hayslip & Patrick, 2003). Chenoweth (2000) has

developed a model for effective grandparent education and recommends that

four content areas be covered: self-care, guidance, communication, and advocacy.

Although a growing number of interventions are being developed to help grand-

parent caregivers meet their needs for information, support, and services, there

exist only a very small number of well-designed studies that address the efficacy

of psychosocial interventions to assist grandparents who are caring for a grand-

child. Consequently, our discussion includes a number of program for which only

anecdotal data exist regarding their effectiveness. We include these programs be-

cause they appear quite promising and warrant a more rigorous evaluation to de-

termine their effectiveness.

Programs for grandparent caregivers can be distinguished by whether they

target more narrowly behavioral change in the individual grandparent or

whether they take a more systemic approach and focus more broadly on the

grandchild as well as the grandparent. Among the interventions targeting the in-

dividual grandparent, Bratton, Ray, and Moffit (1998) used filial/family play

therapy to teach grandparents parenting skills and help them more effectively

support their grandchildren. Hayslip (2003) developed a parent skills/psychoso-

cial skills training program specifically designed for grandparents caring for

grandchildren. The training program consists of six sessions, ranging between

⁄

2 to 2 hours. The 1st week covers parenting skills, including discipline tech-

niques that foster positive self-work and modeling desirable behavior. The next

four sessions teach grandparents how to cope with expressions of grief, depres-

sion, and anger in the grandchild, talking to the grandchild about sex and drugs,

and helping the grandparent understand and deal with school-related problems.

The last session teaches grandparents self-care skills and covers information on

legal and financial issues. Grandparent caregivers who received the training re-

ported greater parenting self-efficacy and improved quality of relationship with

their grandchild (Hayslip, 2003). However, the magnitude of these effects was

modest, and the intervention had no effect on more general measures of well-

being such as life satisfaction and depression.

Burnette (1998) conducted an exploratory, small-scale (N = 11) evaluation of an

8-week school-based group intervention for grandparents based on a stress and

coping model. Each session consisted of a supportive and an educational compo-

nent. The supportive component included discussions of stigma and feelings of

social isolation and concerns about the future care of grandchildren. The educa-

tional component addressed resources and services to grandparents raising

grandchildren, developing coping strategies, and parent skills training. Grand-

parents who participated in the intervention reported lower levels of depression

over the 8-week period. Grandparents also were less likely to use “distancing” as

a coping strategy and were more likely to use problem-focused coping strategies

and to seek social support.

Another group of programs and interventions for grandparent caregivers

takes a more holistic and multifaceted approach, providing an array of services

and supports to grandparent caregivers and their grandchildren. McCallion, Jan-

icki, Grant-Griffin, and Kolomer (2000) developed educational support group ser-

Parenting Grandchildren 415

vices for grandparent caregivers of children with developmental disabilities,

which was supplemented by case management services to the grandchild. The

support group ran a minimum of six sessions, typically held every 2 weeks, with

between 8 to 10 grandparents. To facilitate attendance, in-home or on-site respite

for grandchildren and assistance with transportation was provided. The educa-

tion and support group covered a wide range of topics, including coping

with problem behaviors, custody and guardianship issues, negotiating with the

school and other systems of care, dealing with the parents of the grandchild, and

taking care of oneself (for a complete description, see Kolomer, McCallion, &

Overeynder, 2003). In addition to the support group, case managers assisted

grandparents with such tasks as helping with entitlement programs; obtaining

emergency funds for shelter, housing, and daily expenses; negotiating services

through the disability networks; and completing paperwork for guardianship.

McCallion, Janicki, and Kolomer (2004) found that grandparents in the educa-

tional and support group reported reduced levels of depression and experienced

a greater sense of empowerment and mastery over their care-giving situations

than grandparents in the wait-list control group.

A program developed by Dannison and Smith (2003) used a systems and com-

munity approach involving grandparents, grandchildren, and school personnel.

Separate support groups were held for grandparents and grandchildren. The

support groups met weekly for 8 consecutive weeks. The grandparent group con-

sisted of 8 to 10 participants; the groups for grandchildren were kept small to

enable all children an opportunity to participate. The grandchild group focused

on activities to address the child’s self-esteem, the development of social skills,

and the recognition and appropriate expression of feelings. The grandparent

group taught principles of effective parenting and parent education and allowed

grandparents an opportunity to share their stories. In addition, school personnel

participated in three half-day educational in-service meetings, with the goal of

educating school personnel about the needs of grandparent caregivers and iden-

tifying opportunities to modify the curriculum and school environment to bet-

ter meet the needs of grandparent-headed households. Preliminary evidence

indicated that this systems intervention resulted in improved social skills and

self-confidence in the grandchildren and gains in social support among the

grandparents (Dannison & Smith, 2003).

Project GUIDE (Grandparents United: Intergenerational Development Educa-

tion) is a multifaceted program that provides individual assessment, educational

and support groups, case management services, advocacy, and cultural, social,

and recreational activities for both grandparents and grandchildren. Grandpar-

ents and grandchildren meet weekly for 2 hours. The curriculum for grandpar-

ents, which is delivered over a 52-week period, includes sessions on parenting,

stress management and reduction, health and nutrition, and conflict resolution.

In a descriptive evaluation of the program, Jones and Kennedy (1996) reported

that the program helped reduce social isolation, enhanced parenting skills, as-

sisted families in meeting their basic human needs, and improved the self-esteem

of children.

Project Healthy Grandparents is another multifaceted program organized

around a strengths-based interdisciplinary case management approach to prevent-

ing child neglect. Services are specifically targeted to reduce child neglect and pro-

vide grandparents with the skills necessary to prevent neglect and improve social