Emerging Issues of Custodial Grandparents in Rural Settings

1. Emerging Issues of Custodial Grandparents in Rural Settings Martha R. Crowther, PhD, MPH The University of Alabama at Birmingham Department of Health Behavior crowther@uab.edu Center for Mental Health and Aging, Scientific Seminar SeriesOctober 11, 2004

2. Primary Objective The primary objective of this presentation is to describe the methodological issues that arise in conducting home based research with grandparent caregivers in rural, remote and underserved communities. Project funded by the National Institute on Aging (AG022650-01)

3. Background The past 25 years have seen a dramatic increase in the number of grandparents serving as primary caregivers to their grandchildren & great-grandchildren, often referred to as custodial grandparenting.

4. Grandchildren Living in Home of Grandparent�s with No Parent Present The 2000 Census data estimates that 4.5 million, or 6.3% of children under 18, were living in a grandparent maintained home with no parent present. Bryson, K. (2001)

5. Background Public Health Problem Lack of systemic guidelines for addressing phenomena Clinical practices & research that can systemically examine from contextual & individual perspectives both the problems & resources of custodial grandparents.

6. Characteristics of Custodial Grandparents Female African American 60% more likely to live in poverty More likely to live in the South Crowther, M. & Rodriguez, R. (2003)

7. Alabama Grandchildren Living in Home of Grandparent�s with No Parent Present

8. Summary of Reported Reasons for Custodial Grandparenting Substance Abuse Teenage Pregnancy Child Abuse Neglect Abandonment Death of Parent Parent has AIDS Parental Unemployment Imprisonment

9. Summary of Research on Custodial Grandparenting Health Mobility Time Frustration Fear of substance abusing parent Stress Anger Guilt Restructuring life High risk group of grandchildren

10. Alabama Black Belt Alabama�s Black Belt is a rural region that faces an uncertain economic and cultural future. The 19 counties that comprise the Black Belt are among the poorest in the United States African American population is double the national average Economic stagnation Low education levels Morbidity & mortality rates higher than state or national averages High infant mortality

11. Alabama Black Belt In one of the Black Belt Counties a person can expect to live to about 69 years of age, a shorter life span than Sri Lanka, Iran or Mexico

13. Purpose of Project The project was designed to examine the impact of religiosity and spirituality on coping with the stressors of caregiving and the impact on everyday problem solving and well-being.

14. Design A cross-sectional, case control design was developed to conduct in-home interviews Sample: 200 African American grandparents � raising grandchildren Data collection: ~2 hour semi-structured interview Incentive: $25.00 Walmart gift certificate/cash

15. Design Location: Neutral place High vs. low resource rural counties Meaning of poverty/low income Inner City Rural-close to urban area Rural-remote

16. Design Interviewers chosen from the community Most prior experience with interviewing for other UAB studies Community Health Advisors (CHAs)

17. Project Implementation

19. Methodological Considerations Interviewer Training Communication between research staff & rural staff Explain process Allowing rural staff to tell you about their area Spend time in area if possible

20. Methodological Considerations What is a case? Grandparents appear to keep grandchildren until they are 5 and then give them to the parents Parents move away for employment/education

21. Methodological Considerations Financial considerations for participants Cash instead of Walmart gift certificates because transportation is limited and there is a great distance between shopping areas Financial Considerations for Interviewers Calling cards Pay flat fee (travel, gas, interview time)

22. Methodological Considerations Range in Education 3rd grade level to master�s degree <12 = 72 HS = 54 >12 = 26 Strong sense of community

23. Methodological Considerations Cultural sensitivity Race Geographic (rural) Everyday Problem Solving Test Turkey Microwave Telephone (rotary vs. push button)

24. Methodological Considerations Minority Principal Investigator Tape Recorders Participants concerned about privacy Privacy Conducting in-home interviews that require privacy when private & quiet space is limited

25. Conclusions Alabama�s Black Belt is a rural region characterized by poverty and sociocultural transition. Conducting research with rural residents is important, however, to ensure adequate data the investigator must be sensitive to subcultural norms and the needs of the community. The investigator must be willing to employ multiple strategies to gain access, recruit, and train local interviewers for ongoing research.

26. Conclusions Participants still coming after data collected Received thank you note from interviewers

27. Implications Investigators should invest time in understanding the rural community and building community relations to ensure the quality of their data and continued access to the rural population.

28. Building Collaborative Ties

29. References Bryson, K. (2001). New census bureau data on grandparents raising grandchildren. The Gerontological Society of America Annual Scientific Meeting, Chicago, IL, November 2001. Crowther, M. & Rodriguez, R. (2003). Stress and Coping Model of Custodial Grandparenting Among African Americans. In B. Hayslip & J. Patrick (Eds.), Working with Custodial Grandparents. New York: Springer Publications (pp.145-162). Joslin. D., & Harrison, R. (1998). The hidden patient, Older relatives raising children orphaned by AIDS. Journal of American Medical Women's Association, 5, 65-71. Fuller-Thomson, E., Minkler, M., & Driver, D. (1997). A profile of grandparents raising grandchildren in the United States. The Gerontologist, 37, 406-411. Harrison, K.A., Richman, G.S., Vittimberga, G.L. (2000). Parental stress in grandparents versus parents raising children with behavior problems. Journal of Family Issues, 21, 262-270. Landry, L. (1999). Research into action: Recommended intervention strategies for grandparent caregivers. Family Relations, 48, 381-390. Minkler, M, Fuller-Thomson, E. (1999). The health of grandparents raising grandchildren: Results of a national study. American Journal of Public Health, 89 (8), 1-6.

30. References Minkler, M., & Roe, K. M. (1993). Grandparents as caregivers, Raising grandchildren of the crack cocaine epidemic. Newbury Park, CA, Sage. Minkler, M., Roe, K. M., & Price, M. (1992). The physical and emotional health of grandparents raising grandchildren in the crack cocaine epidemic. The Gerontologist, 32, 752-761. Musil, C.M., Youngblut, J.M., Ahn, S., Curry, V.L.(2002). Parenting stress: A comparison of grandmother caretakers and mothers. Grand Parenting Stress, 197-210. Myers, L.M., Kropf, N.P., Robinson, M. (2002). Grandparents raising grandchildren: Case management in a rural setting. Journal of Human Behavior in the Social Environment, 5, 53-71. Poindexter, C.C. (2004). �It don�t matter what people say as long as I love you�: Experiencing stigma when raising an HIV-infected grandchild. In C.A. Emlet (Ed.), HIV/AIDS and Older Adults Challenges for Individuals, families, and Communities (pp.131-156). New York, NY: Springer Publishing Company. Robinson, M.M., Kropf, N.P., Myers, L.L. (2000). Grandparents raising grandchildren in rural communities. Journal of Mental Health and Aging, 6, 353-365. Sands, R. G., & Goldberg-Glen, R. S. (2000). Factors associated with stress among grandparents raising their grandchildren. Family Relations, 49 (1), 97-105.

31. Thank You!