Health and Health Services

Articles in this section focus on the health and wellbeing of grandfamilies. They discuss prevalent  health challenges for grandfamilies, services that address these problems and recommendations to better manage health-related issues.

1. Bachay, Judith B., and Barbara M. Buzzi. “Grandparents Raising Grandchildren: Challenges and Opportunities for Mental Health Practitioners.” American Counseling Association Journal (2012): 1-11.

By outlining the rising prevalence of grandfamilies in the U.S., the authors of this article call for mental health practitioners to adjust their services to better meet the complex needs of grandfamilies. Specifically they identify three types of family therapy that could be useful in serving grandfamilies: filial family therapy, narrative therapy, structural therapy.

2. Baker, Lindsey A., and Merril Silverstein. “Depressive symptoms among grandparents raising grandchildren: The impact of participation in multiple roles.” Journal of Intergenerational Relationships 6, no. 3 (2008): 285-304.

This article utilizes results from the 2000-2002 Health and Retirement Study to examine the wellbeing among different groups of grandparents raising grandchildren. The authors specifically look at the difference in the prevalence of depressive symptoms among grandparents who are raising grandchildren and are also participating in multiple outside roles (work, volunteering, etc.) to those grandparent-caregivers who are not participating in multiple outside roles. Their results indicated that grandparent participation in multiple roles increases mental stressors and the likelihood of depression. However, they also found that the length of time in which grandparents have been caring for grandchildren is an important factor to consider: with grandparents, who recently began caring for their grandchildren, having their wellbeing decline when participating in multiple roles compared to grandparents, who have been raising their grandchildren for longer of periods of time, actually benefiting from participation in multiple roles.

3. Barnett, Melissa A., Loriena Yancura, Joe Wilmoth, and Yoshie Sano. “Wellbeing Among Rural Grandfamilies in Two Multigenerational Household Structures.” GrandFamilies: The Contemporary Journal of Research, Practice and Policy 3, no. 1: 4.

This article examines the health and wellbeing needs of an understudied type of grandfamily: multi-generational households or households where there is grandparent-parent-child co-residence. The authors look specifically at multi-generational families in rural areas, using data collected from a survey addressing health status as connected to other factors like economic security, family relationships and parenting routines. The authors identify how services geared toward multi-generational families can potentially help these families manage greater wellbeing.

4. Cheung, Connie, Deborah Goodman, George Leckie, and Jennifer M. Jenkins. “Understanding contextual effects on externalizing behaviors in children in out-of-home care: Influence of workers and foster families.” Children and Youth Services Review 33, no. 10 (2011): 2050-2060.

This article demonstrates how children placed in kinship care show lower levels of externalizing behavior in comparison to non-kinship foster care, while children placed in group care show higher levels (Childfocus).

5. Cooney, Teresa M., and Jeong Shin An. “Women in the middle: Generational position and grandmothers’ adjustment to raising grandchildren.” Journal of women & aging 18, no. 2 (2006): 3-24.

 The study that this article reports examined the tendency of caregiving grandmothers who had living parents or in-laws (G2) to have a higher burden and depression level than those grandmothers who were the eldest generation in their families (G1). After controlling for variables associated with generational positions, the results supported the hypothesis that grandmothers in the G2 generation reported greater burden and depression in their caregiving roles than grandmothers in the G1 generation.

6. Cornelius, Judith Bacchus, Sara LeGrand, and Loretta Jemmott. “African American grandparents’ and adolescent grandchildren’s sexuality communication.” Journal of family nursing (2008).

This article concerns the difficulty African American grandparents face in communicating with their adolescent grandchildren on topics of sexual health. It relies on data from a study of 40 grandparent- grandchild pairs and which asked both grandparents and grandchildren their feelings about sexuality communication.

7. Doley, Rebekah, Ryan Bell, Bruce Watt, and Hannah Simpson. “Grandparents raising grandchildren: investigating factors associated with distress among custodial grandparents.” Journal of Family Studies 21, no. 2 (2015): 101-119

This study explores the relationship between the psychological health of grandparent caretakers and the social, emotional and behavioral issues of their grandchildren. The study also assesses the relationship between psychological well-being in grandparents and access to informal social support. Results from a sample of 100 grandparents indicated that those caring for grandchildren with emotional and behavioral issues reported greater levels of anxiety, stress and depression. Although grandparents with greater access to informal social support experienced less depression and anxiety, they did not feel it lessened the impact of raising children with multiple issues. The authors then discuss recommendations for intervention-type services to assist grandfamilies.

8. Fechter-Leggett, Molly O., and Kirk O’Brien. “The effects of kinship care on adult mental health outcomes of alumni of foster care.” Children and Youth Services Review 32, no. 2 (2010): 206-213.

Having a close relationship with an adult, such as a kinship caregiver, was found to be a predictor of more positive mental health as an adult (ChildFocus).

9. Garcia, Antonio, Amanda O’Reilly, Meredith Matone, Minseop Kim, Jin Long, and David M. Rubin. “The influence of caregiver depression on children in non-relative foster care versus kinship care placements.” Maternal and child health journal 19, no. 3 (2015): 459-467.

Children in kinship care experience better behavioral outcomes than children in non-relative foster care. Emotional and behavioral outcomes among children in kinship placements are more likely to improve when caregivers demonstrate a reduction in depression over time or are never depressed (ChildFocus).

10. Goodman, Catherine Chase, and Merril Silverstein. “Latina grandmothers raising grandchildren: Acculturation and psychological well-being.” The International Journal of Aging and Human Development 60, no. 4 (2005): 305-316.

The study that this article discusses examined socioeconomic and familial factors that related to the well-being among nearly 400 studied Latina kinship care providing grandmothers in the context of acculturation. Positive and negative affect were attributed to various factors that signaled inclusion with or exclusion from mainstream society (language acculturation, social resources, marriage, in-home parent, etc.). The results showed that professions should target new immigrants and work with unconventional at-home life.

11. Hayslip, Bert, Heidemarie Blumenthal, and Ashley Garner. “Social support and grandparent caregiver health: One-year longitudinal findings for grandparents raising their grandchildren.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 70, no. 5 (2015): 804-812.

This article examines the relationship between social support and overall health of grandparents raising grandchildren. Using results from a 1-year longitudinal study of 86 grandparent participants, the authors found that social support predicted health and study participants cited greater social support also reported greater overall health: including decreases in depressive symptoms and the adverse effects of parental stress.

12. Hughes, Mary Elizabeth, Linda J. Waite, Tracey A. LaPierre, and Ye Luo. “All in the family: The impact of caring for grandchildren on grandparents’ health.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 62, no. 2 (2007): S108-S119.

The authors of this article analyze data taken from a sample of over 12,000 grandparents in relation to a study on the relationship between grandchild care and grandparent health. Controlling for the covariates of previous health, the results of the study provide no evidence to suggest that grandparents experience negative health changes when taking on the role of care provider for their grandchildren.

13. Kresak, Karen E., Peggy A. Gallagher, and Susan J. Kelley. “Grandmothers Raising Grandchildren With Disabilities Sources of Support and Family Quality of Life.” Journal of Early Intervention 36, no. 1 (2014): 3-17.

In this article, sources of support and quality of life of 50 grandmother-headed families raising grandchildren with and without disabilities are examined. Comparative analyses revealed significant differences between grandmothers raising grandchildren with and without disabilities in regard to sources of support and family quality of life. Informal support was significantly higher for grandmothers raising grandchildren without disabilities. In addition, grandmothers raising grandchildren without disabilities rated satisfaction with all aspects of family quality of life except parenting as significantly higher than grandmothers raising grandchildren with disabilities. Correlational analyses showed a moderate correlation between sources of support and family quality of life for both groups of grandmothers. While total informal social support was significantly correlated with satisfaction ratings of family quality of life for both groups of grandmothers, total formal support was significantly correlated with satisfaction ratings of family quality of life only for grandmothers raising grandchildren with disabilities. Multiple regression analyses revealed a significant relationship between presence of child disability and satisfaction ratings of family quality of life (Journal of Early Intervention).

14. Marken, Dory M., and Jenna B. Howard. “Grandparents raising grandchildren: The influence of a late-life transition on occupational engagement.” Physical & Occupational Therapy In Geriatrics 32, no. 4 (2014): 381-396.

This article focuses on the issue of grandparents who are raising their grandchildren replacing previous participation in social, leisure and physical activities with child-rearing responsibilities. The loss of participation in the aforementioned activities has been linked with decline in physical and mental health. The authors of this article employed a demographic questionnaire to examine activity involvement among grandparents and its effect on mental and physical health. Of the ten grandparents who took part in the study, the authors found that grandfathers retained an appreciably higher level of activity involvement compared to grandmothers and that at least 4 grandmothers cited raising a child as having a negative impact on their physical and emotional wellbeing. Using the results of the study, the authors provide recommendations on how occupational therapists can support grandparents’ re-establishment of leisure, social, and more demanding physical activity to avert functional health decline.

 15. McKinney, Chelsea O. “Early Childhood Overweight and Obesity in Multigenerational Households.” GrandFamilies: The Contemporary Journal of Research, Practice and Policy 2, no. 1: 2.

The epidemic of early childhood obesity is an ongoing and serious threat to the health of children in America. This article examines the studied link between early childhood obesity and weight problems and co-residence with grandmothers. Among other influencing factors such as socioeconomic status and race/ethnicity, the authors identify grandmother co-residence as negatively influencing the weight of young children. As a possible solution, they recommend prevention and weight management programs that specifically accommodate multi-generational households.

16. Nyesigomwe, Lydia. “Strengthening the capacity of grandparents in providing care to young children affected by HIV/AIDS.” Journal of Intergenerational Relationships 4, no. 1 (2006): 55-63.

This article focuses on the results of a three-year pilot project entitled Grandparents Action Support Project (GAS), implemented by the NGO Action for Children (AFC) in Uganda. The purpose of the project is to strengthen the capacity of grandparents in providing care for HIV/Aids orphans in Uganda as well as the overall health and wellbeing of Ugandan grandfamilies. The author discusses the achievements and impact of the project in its base community as well as some organizational challenges and ideas for future expansion.

17. O’Hora, Kendra A., and Megan L. Dolbin-MacNab. “Practice recommendations for mental health professionals: Perspectives from grandparents and their adolescent grandchildren.” GrandFamilies: The Contemporary Journal of Research, Practice and Policy 2, no. 1 (2015): 5.

 The authors of this article examine the unique needs of grandfamilies who utilize mental health services in their communities in order to better aid professionals in helping grandparents and grandchildren. They discuss the qualitative results of a survey that interviewed 40 grandmothers and their grandchildren on their experiences with mental health services. Using these results, the authors outline key recommendations to improve services for grandfamilies.

18. Marken, Dory M., and Jenna B. Howard. “Grandparents raising grandchildren: The influence of a late-life transition on occupational engagement.” Physical & Occupational Therapy In Geriatrics 32, no. 4 (2014): 381-396.

This study explores the relationship between the psychological health of grandparent caretakers and the social, emotional and behavioral issues of their grandchildren. The study also assesses the relationship between psychological well-being in grandparents and access to informal social support. Results from a sample of 100 grandparents indicated that those caring for grandchildren with emotional and behavioral issues reported greater levels of anxiety, stress and depression. Although grandparents with greater access to informal social support experienced less depression and anxiety, they did not feel it lessened the impact of raising children with multiple issues. The authors then discuss recommendations for intervention-type services to assist grandfamilies.

19. Rubin, David M., Kevin J. Downes, Amanda LR O’Reilly, Robin Mekonnen, Xianqun Luan, and Russell Localio. “Impact of kinship care on behavioral well-being for children in out-of-home care.” Archives of Pediatrics & Adolescent Medicine 162, no. 6 (2008): 550-556.

Children placed into kinship care had fewer behavioral problems 3 years after placement than children who were placed into traditional foster care. Children who moved to kinship care after a significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset.

20. Sprang, Ginny; Choi, Moon; Eslinger, Jessica; Whitt-Woosley, Adrienne; and Looff, Rachel, “Grandparents as Parents: Investigating the Health and Well-Being of Trauma-Exposed Families” (2014). Center on Trauma and Children Reports. Paper 1.

This paper focuses on the impact that trauma-related stress and emotional difficulties has on grandfamilies and the relationship between grandparent and grandchild. The authors examine data taken from a study conducted on trauma-exposure, stress and emotional wellbeing and whose participants were grandparent caregivers in the state of Kentucky. The results of this study indicated that grandparents with grandchildren who experienced levels of trauma in previous care, experienced higher levels of stress and other emotional and physical health difficulties in raising their grandchildren. Using these results, the authors identify key health service needs for grandfamilies affected by trauma-related issues.