Does Social Intelligence Training Improve Daily Well-Being and Responsiveness to Daily Negative and Positive Events in Custodial Grandmothers?

OBJECTIVES: Custodial grandparents are grandparents who raise grandchildren on a full-time basis in absence of the grandchild's birth parents. Compared to non-caregiving grandparents, custodial grandparents report poorer mental and physical health and stronger changes in daily well-being when experiencing negative and positive events. We examine whether an online social intelligence training (SIT) program improves custodial grandmothers' (CGM) daily well-being, socio-emotional skills, and changes in well-being when confronted with daily negative and positive events. METHOD: Multilevel models were applied to 200 CGM who were recruited from across the U.S. and completed a daily survey for 14 consecutive days prior to and following participation in a randomized clinical trial. Participants were randomized into the SIT program or an attention control condition focusing on healthy living habits. The outcomes of interest were daily well-being, social connectedness, emotional awareness, and perspective-taking. RESULTS: Multilevel analyses revealed that participants who participated in the SIT program, compared to the attention control condition, exhibited stronger emotional responsiveness (i.e., improvements) to daily positive events in the outcomes of positive affect, social engagement, and perspective-taking. DISCUSSION: Our findings illustrate that SIT improves key components of daily functioning in CGM, which may serve as a pathway linking the demands of custodial grandparenting to poorer mental and physical health. Our discussion focuses on the utility and accessibility of the SIT program for helping improve outcomes for this disadvantaged population.

A Randomized Clinical Trial of Online Social Intelligence Training With Custodial Grandmothers.

BACKGROUND AND OBJECTIVES: In this study, we investigated the efficacy of a self-administered, online Social Intelligence Training (SIT) program aimed at enhancing psychological and relational well-being among a nationwide U.S. sample of custodial grandmothers. RESEARCH DESIGN AND METHODS: A two-arm randomized clinical trial (RCT) was conducted, where 349 grandmothers raising grandchildren aged 11-18 years were assigned to either SIT or an attention control condition (ACC). Participants self-completed online surveys at baseline and immediately postintervention, in addition to follow-ups at 3-, 6-, and 9-month postintervention. First-order latent difference score models were used to compare SIT to ACC, across all times of measurement, along key indicators of psychological and relational well-being on an intent-to-treat basis. RESULTS: Although SIT was largely superior to ACC at yielding positive results, it appears that it attenuated longitudinal declines that occurred among ACC participants. SIT also exerted stronger effects on relational than psychological outcomes, with perceived relations with grandchildren being the most positively affected. DISCUSSION AND IMPLICATIONS: Given that the historical time of this RCT unpredictably corresponded with the coronavirus disease 2019 pandemic, we suspect that SIT helped offset declines in psychological and relational well-being that are widely documented to have resulted from the pandemic. Our overall positive findings support future use of the inexpensive and easily delivered SIT program under normal environmental conditions, with the vulnerable and geographically disperse population of custodial grandmothers. CLINICAL TRIALS REGISTRATION NUMBER: NCT03239977.

Intergenerational patterns of attachment in custodial grandfamilies.

The present study aimed to identify intergenerational patterns of attachment insecurity among grandmothers, adolescent grandchildren, and birth mothers in custodial grandfamilies and to test the relations among triadic attachment patterns and grandchild socioemotional outcomes. Prior research with custodial grandfamilies has found distinct "profiles" reflecting patterns of closeness between grandmothers, grandchildren, and birth mothers. However, no studies have tested patterns of attachment insecurity among members of the triad, despite the likelihood of attachment disruption in grandfamilies. Moreover, previous studies have only examined links between profile and grandmother outcomes or rudimentary grandchild outcomes. In a sample of 230 grandmother-grandchild dyads from a larger randomized controlled trial testing the efficacy of an online social intelligence training program for grandfamilies, latent profile analysis (LPA) was conducted to identify profiles of intergenerational attachment insecurity, using grandmother and grandchild reports. Profile differences in grandchild internalizing and externalizing problems, social skills, self-esteem, and prosocial behavior were examined. We identified three profiles: isolated mother, grandchild-linked, and disconnected. Overall, grandchildren in disconnected families (in which attachment insecurity between all three members of the triad was high) fared worst. Grandchildren in isolated mother families (in which only grandmother-grandchild attachment insecurity was low) fared best. A secure attachment relationship between grandmother and adolescent grandchild may buffer effects of attachment insecurity between the grandchild and birth mother. These findings inform intervention efforts and highlight the utility of family- and attachment-focused research for building understanding of custodial grandfamilies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Grandmother and Grandchild Reports of Psychological Difficulties Among Custodial Grandchildren: Whose View Matters and Why is It Important?

We conducted this first ever study comparing reports of custodial grandchildren's (CG) psychological difficulties obtained jointly from 163 custodial grandmothers (CGM) and their CG between ages 6-12. Internalizing and externalizing difficulties were indicated by whether any of the corresponding scales on the Strengths and Difficulties Questionnaire (SDQ, reported by CGM) or Dominic Interactive (DI, reported by CG) reached the 90th percentile. Internalizing and externalizing difficulties were reported by informant types at rates higher than those typically observed in the general population, with externalizing difficulties being more prevalent among male CG. At the dichotomous level of (dis)agreement, nearly two-thirds of informant pairs showed concordance regarding whether or not they reported the CG at the 90th percentile on either externalizing and internalizing difficulties. When (dis)agreement was further broken into four specific categories (i.e., "neither report", "both report", "CGM only", and "CG only", CGM's use of mental health services, race, depressive and anxiety symptoms, harsh/punitive discipline, and warmth impacted such concordance as did CG's gender, age, and use of mental health services. The overall findings were remarkably similar regardless of which specific SDQ and DI scales were used in the analyses. The present study unearths new ground regarding the extent to which grandchildren's distress is similarly perceived by CG themselves versus their CGMs. Such findings are important to the extent that accurate estimates exist regarding the emotional difficulties CG face and lay the groundwork for timely and efficacious interventions designed to alleviate their distress.

The Dynamics of Daily Life in Custodial Grandmothers.

OBJECTIVE: Guided by a life-course perspective, we examine the nature of daily life among custodial grandmothers (CGM) through documenting daily positive and negative affect, reporting daily negative and positive events, and emotional reactivity/responsiveness to daily negative and positive events. We also examine whether CGM age, adverse childhood experiences (ACEs), and social relationship quality with grandchild are associated with each indicator. METHODS: We applied multilevel models to 200 CGM (Mage = 61, SD = 5.66) who were recruited from across the United States and completed a daily survey for 14 consecutive days prior to commencing a randomized clinical trial. RESULTS: Older age and reporting fewer ACEs were associated with better overall and less variability in daily well-being. Positive events were reported on 83% of days and negative events were reported on 56% of days. Daily well-being was lower when a negative event was reported and higher when a positive event was reported. Reporting more ACEs was associated with greater exposure to daily negative events and stronger gains in daily well-being when a daily positive event was reported. Older age was associated with lesser declines in daily well-being on days when a negative event was reported. DISCUSSION: In accordance with the life-course perspective, our findings illustrate how the timing of being a CGM (age) and the cumulative nature of development (ACEs) affect daily well-being and negative and positive events for CGM. Our discussion focuses on resources to consider when building resilience-focused interventions for promoting the health and well-being of CGM.

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.

The Role of Social Services in Reunified Custodial Grandfamilies.

Social services, including the child welfare system, are often heavily involved in situations where children are returned to the care of their parents, after being raised in kinship care by their grandparents. While previous research has highlighted custodial grandparents' service needs and the challenges they experience when accessing services and working with social service professionals, few studies have examined social services in the context of reunifying grandfamilies. Informed by bioecological theory, the aim of this qualitative study was to examine custodial grandmothers' perceptions of the role of social services in the process of their grandchildren being reunified with a biological parent. Semi-structured, in-depth interviews were conducted with a purposeful sample of 16 custodial grandmothers whose grandchildren had experienced reunification. Findings from a grounded theory analysis revealed grandmothers' perceptions that having a strong connection with a responsive caseworker facilitated successful reunification, as did ongoing efforts to address the parental issues that had resulted in the grandmother assuming a custodial role. Unfortunately, grandmothers also perceived barriers to successful reunification. These included having their perspectives dismissed by caseworkers and judges as well as the child welfare system prioritizing reunification, often to the perceived detriment of their grandchildren. Implications for policy and practice with reunifying grandfamilies are addressed.

Predictors and moderators of treatment efficacy in reducing custodial grandmothers' psychological distress.

It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.

Appraisals of Self in the Caregiver Role as Made by Married Custodial Grandparents.

OBJECTIVE: We examined how married custodial grandparents from the same household appraise the impact of caring for a grandchild on their sense of self, and how these appraisals are related to their psychological well-being. BACKGROUND: This study is important because there is scant information on how custodial grandmothers and grandfathers both experience their caregiver role, even though 70% of these grandparents are married. METHOD: Four competing measurement and structural models from the combined perspectives of the stress process model and the two-factor model of caregivers' psychological well-being were tested with 193 married grandmothers and grandfathers. RESULTS: The best fitting model was one in which two positive (personal gain and satisfaction) and two negative (loss of self and role captivity) appraisals emerged as distinct first-order constructs. Both negative appraisals correlated highest with negative affect, and both positive appraisals correlated highest with positive affect. The measurement and structural components of this model were largely invariant by grandparent gender. Mean comparisons showed that grandmothers reported significantly higher negative appraisals than grandfathers, with the latter reporting significantly greater perceived gain in the caregiving role. Bivariate correlations between grandmothers' and grandfathers' appraisals were nonsignificant for perceived gain and loss of self and of only moderate magnitude for caregiver satisfaction and role captivity. CONCLUSIONS: Given that appraisals are a core component of coping with stressors, our findings have important practice implications and point to meaningful directions for future research regarding custodial grandparent families.

Reunification in Custodial Grandfamilies: An Examination of Resilient Family Processes.

OBJECTIVE: This study examined how custodial grandmothers navigated the process of their grandchildren being reunified with a biological parent. BACKGROUND: Prior research has focused on factors associated with unsuccessful reunification instead of resilient family processes that may support successful reunification. How custodial grandfamilies navigate reunification has not been examined, despite their unique relational configuration and grandparents' frequent involvement in raising their grandchildren. METHOD: Guided by Walsh's model of family resilience, semistructured, in-depth qualitative interviews were conducted with a convenience sample of 17 grandmothers whose custodial grandchildren had been reunified with a biological parent. Data analysis was guided by grounded theory methodology. RESULTS: Grandmothers believed in parents fulfilling their obligations, prioritizing grandchildren's needs, and coping via their faith. Grandmothers supported reunified parents and children by providing emotional support and instrumental assistance, while maintaining clear role boundaries. Accessing resources and engaging in open family communication were helpful to the reunification, although there were still challenges in navigating family relationships. CONCLUSION: Within custodial grandfamilies, not all reunifications were a positive outcome for the grandchildren. Grandmothers remained heavily involved in supporting and monitoring the reunifications, with the quality of the grandmother-parent relationship being paramount. IMPLICATIONS: Practitioners should address family dynamics when working with custodial grandfamilies before, during, and after a reunification.

Polar Ocean Observations: A Critical Gap in the Observing System and Its Effect on Environmental Predictions From Hours to a Season.

There is a growing need for operational oceanographic predictions in both the Arctic and Antarctic polar regions. In the former, this is driven by a declining ice cover accompanied by an increase in maritime traffic and exploitation of marine resources. Oceanographic predictions in the Antarctic are also important, both to support Antarctic operations and also to help elucidate processes governing sea ice and ice shelf stability. However, a significant gap exists in the ocean observing system in polar regions, compared to most areas of the global ocean, hindering the reliability of ocean and sea ice forecasts. This gap can also be seen from the spread in ocean and sea ice reanalyses for polar regions which provide an estimate of their uncertainty. The reduced reliability of polar predictions may affect the quality of various applications including search and rescue, coupling with numerical weather and seasonal predictions, historical reconstructions (reanalysis), aquaculture and environmental management including environmental emergency response. Here, we outline the status of existing near-real time ocean observational efforts in polar regions, discuss gaps, and explore perspectives for the future. Specific recommendations include a renewed call for open access to data, especially real-time data, as a critical capability for improved sea ice and weather forecasting and other environmental prediction needs. Dedicated efforts are also needed to make use of additional observations made as part of the Year of Polar Prediction (YOPP; 2017-2019) to inform optimal observing system design. To provide a polar extension to the Argo network, it is recommended that a network of ice-borne sea ice and upper-ocean observing buoys be deployed and supported operationally in ice-covered areas together with autonomous profiling floats and gliders (potentially with ice detection capability) in seasonally ice covered seas. Finally, additional efforts to better measure and parameterize surface exchanges in polar regions are much needed to improve coupled environmental prediction.

Psychological Difficulties among Custodial Grandchildren.

Although custodial grandchildren (CG) are likely to have more emotional and behavioral problems than children in general, only a handful of studies involving nationally representative data have investigated this important public health issue. The present study is unique in examining informant reports of psychological difficulties and prosocial behavior, obtained via the Strengths and Difficulties Questionnaire (SDQ) parent version, regarding two samples (n = 509 and n = 323) of CG between ages 4-12 and three samples of age peers from the 2004 National Health Interview Survey (NHIS) residing in homes with either no birth parent (n=184), one parent (n = 1,618), or both parents (n = 3,752). A MANCOVA encompassing the main effects of sample type, child gender, and informant's race across six SDQ subscales (with informant age and education, as well as child age controlled) showed all three main effects to be statistically significant (p < .001). Between subjects effects for sample type were significant for all six subscales (p <.001), with a general pattern found whereby the two CG samples had higher difficulty and lower prosocial scores than all three NHIS samples, with corresponding effect sizes falling in the moderate to very large range. Tests of between subjects effects for child gender showed, that regardless of sample type, males typically had higher difficulty scores and lower prosocial scores than those for females. Tests of between subjects effects by informant's race showed only sporadic differences that were independent of sample type. Comparisons of the SDQ banded scores suggested that CG have considerably different cutoff points than do children in other family structures to indicate a likely diagnosis of a serious psychological disorder. We conclude that primary school aged CG are at an especially high risk for both internalizing and externalizing difficulties regardless of children's gender or informant's race.

A randomized clinical trial of interventions for improving well-being in custodial grandfamilies.

Despite the rising cultural phenomenon of grandparents parenting grandchildren on a full-time basis due to problems within the birth parent generation, intervention studies with these families have been scarce, methodologically flawed, and without conceptual underpinnings. We conducted a randomized clinical trial (RCT) with 343 custodial grandmothers recruited from across 4 states to compare the effectiveness of behavioral parent training (BPT), cognitive-behavioral therapy (CBT), and information-only control (IOC) conditions at lowering grandmothers' psychological distress, improving their parenting practices, and reducing the internalizing and externalizing difficulties of target grandchildren between ages 4 and 12. These outcomes were derived conceptually from the family stress model and modeled as latent constructs with multiple indicators. Each RCT condition was fully manualized and delivered across 10 sessions within groups led jointly by trained professionals and peer facilitators in community settings. Multidomain second-order latent difference score models were performed on a full intent-to-treat basis to compare the 3 RCT conditions on changes in the above outcomes from baseline to postintervention and from baseline to 6 months postintervention. In general, while CBT and BPT interventions were both superior to IOC at both times of measurement on most outcomes, they differed little from each other. Effect sizes were generally in the moderate to large range and similar to those found in prior studies of BPT and CBT with traditional birth parents. We conclude from this research that evidence-based interventions focusing on appropriate skill development and behavioral change can yield positive outcomes within custodial grandfamilies. (PsycINFO Database Record

The Family Stress Model as it Applies to Custodial Grandfamilies: A Cross Validation.

There is scant research on how the parenting practices of custodial grandmothers affect the psychological adjustment of grandchildren in their care. Yet, the findings from a handful of prior studies suggest the relevance of the Family Stress Model (FSM) to these caregivers. The present study further tested the FSM with baseline data from 343 custodial grandmothers (Mage= 58.5 years) enrolled in a clinical trial of the efficacy of interventions for improving the well-being of their families. Not only was this "help-seeking" sample atypical of prior FSM studies, but also unique to the present study was our addition of multiple parenting practices, self-reported and clinical ratings of grandmothers' distress, and reports of grandchildren's internalizing and externalizing difficulties from grandchildren and grandmothers. Mplus 7.31 was used to test a model where the effect of grandmother distress on grandchildren's internalizing and externalizing difficulties was hypothesized to be indirect through five distinct parenting practices. The findings regarding both the measurement and structural models fit the observed data well, and invariance was largely found across grandchildren's gender and age (4-7 vs. 8-12). Although grandchildren's self-reported internalizing and externalizing difficulties were unrelated to grandmothers' distress and parenting practices, the grandmothers' reports of these outcomes were generally related to their own distress and parenting practices as hypothesized. However, considerable variation was found across the five parenting practices in terms of their relationships to the other FSM constructs. We conclude that data from multiple informants and measures of assorted parenting practices are essential to future research and practice.

The Utility of the Family Empowerment Scale With Custodial Grandmothers.

The Family Empowerment Scale (FES) was developed specifically to assess empowerment in families with emotional disorders. Its relevance to custodial grandfamilies is reflected in the difficulties in grandchildren's social, emotional, and behavioral functioning, wherein such difficulties may be explained via either reactions to changes in their family structure or in their responses to the newly formed family unit. Utilizing 27 items derived from the 34-item version of the FES, which had represented differential levels of empowerment (family, service system, community) as indexed by one's attitudes, knowledge, and behavior, we explored the factor structure, internal consistency, construct, and convergent validity of the FES with grandparent caregivers. Three-hundred forty-three ( M age = 58.45, SD = 8.22, n Caucasian = 152, n African American = 149, n Hispanic = 38) custodial grandmothers caring for grandchildren between ages 4 and 12 years completed the 27 FES items and various measures of their psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. Factor analysis revealed three factors that differed slightly from the originally proposed FES subscales: Parental Self-Efficacy/Self-Confidence, Service Activism, and Service Knowledge. Each of the factors was internally consistent, and derived factor scores were moderately interrelated, speaking to the question of convergent validity. The construct validity of these three factors was evidenced by meaningful patterns of statistically significant correlations with grandmothers' psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. These factor scores were independent of grandmother age, health, and education. These findings suggest the newly identified FES factors to be valuable in understanding empowerment among grandmother caregivers.

Patterns of Enrollment and Engagement of Custodial Grandmothers in a Randomized Clinical Trial of Psychoeducational Interventions.

The authors used Andersen's (2008) behavior model to investigate patterns of enrollment and treatment engagement among 343 custodial grandmothers who participated in a randomized clinical trial of three psychosocial interventions:(a) a behavioral parenting program, (b) a cognitive behavioral coping program, or (c) an information-only condition. Treatment completion was superior to that typically found with birth parents, even though the grandmothers and their target grandchildren both had high levels of mental and physical health challenges. Compliance did not differ significantly by condition but was higher among grandmothers who self-reported less positive affect, were older, and were using mental health professionals. Treatment satisfaction was highest in grandmothers who attended more treatment sessions, reported lower annual family income, had a health problem, and were using mental health professionals. The practice and policy implications of these findings are discussed, especially in terms of strategies for enhancing the engagement of custodial grandfamilies in future psychoeducational interventions.

Measuring the Parenting Practices of Custodial Grandmothers.

Despite increased interest in parenting among custodial grandmothers (CGM), there is scant research on assessing their parenting practices. With CGMs as informants we examined the factor structure for five self-report scales developed as measures of parental nurturance and discipline with birth parents, and then tested for measurement invariance by grandchildren's age (4 - <7 versus ≥7 - 12). We also examined concurrent validity for these scales according to the Family Stress Model. Data were from 343 CGMs (M = 58.45, SD = 8.22) enrolled in a randomized clinical trial caring for grandchildren (GC) aged 4 to 12 (M = 7.81, SD = 2.56). Discipline was assessed by three scales from the Parental Behavior Inventory (Consistency, Effective, and Punitive). Nurturance was assessed by the Positive Affect Index and the Supportive Engaged Behavior scale of the Parenting Practice Interview. Confirmatory factor analysis (CFA) revealed that these scales were best represented as five distinct yet covarying factors (RMSEA = .055; SRMR = .07). Follow-up CFAs within each GC age group supported this model, with only few changes suggested by the corresponding diagnostic tests. A model with these changes was then examined for measurement invariance by CG age group, with complete measurement invariance found and all items loading onto their respective factors significantly. The five scales also correlated as expected with indices of CGM psychological distress and GC adjustment. We conclude that the scales examined here can be used meaningfully with CGM as respondents.

Impact of Coping Resources on the Well-Being of Custodial Grandmothers and Grandchildren.

The authors blended elements from the Stress Process Model and the Family Stress Model to investigate the direct and indirect effects of custodial grandmothers' (CGMs') coping resources (i.e., active strategies, passive strategies, and social support) on their psychological distress, their parenting practices, and their grandchild's internalizing and externalizing symptoms. Participants included African American and White CGMs (N = 733, M age = 56) who provided full-time care to a grandchild (Mage = 9.8). Structural equation modeling revealed that social support and active coping were related to lower CGM distress and less ineffective parenting, whereas passive coping was associated with increased distress and more ineffective parenting. Ineffective parenting had direct effects on grandchildren's outcomes, whereas CGM coping resources had direct effects on ineffective parenting and indirect effects (through ineffective parenting) on grandchildren's externalizing and internalizing difficulties. The authors conclude that CGM coping resources affect the psychological well-being of both generations.

Group Leaders' Perceptions of Interventions with Grandparent Caregivers: Content and Process.

Nineteen (Mage = 45, SD = 12.8) group leaders who received extensive leadership training were surveyed regarding their experiences in leading a 10-week program with one of three randomized clinical trial (RCT) conditions (cognitive behavior training, parenting skills training, information-only support). While a high percentage indicated that the intervention led by them was beneficial, leaders nevertheless felt that some participants benefited more so than others. Perceived program benefits were linked to regular attendance and the completion of weekly homework. The major benefits to participants were gaining personal insight, receiving and providing support to others, successfully applying learned skills and knowledge to everyday life, and feeling empowered and hopeful about the future. Peer leaders were viewed positively, as was the provision of food and childcare. Group leaders faced numerous practice challenges in conducting group interventions: ensuring regular attendance, keeping participants focused and on track, and dealing with participants who dominated discussions. These unprecedented findings not only allow us insight into the dynamics of leading group interventions with grandmother caregivers, but they may also have implications for influences on the measured efficacy of such programs.