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.

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.

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.

Program and practice elements for placement prevention: a review of interventions and their effectiveness in promoting home-based care.

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

Trauma adapted family connections: reducing developmental and complex trauma symptomatology to prevent child abuse and neglect.

Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and prevent child abuse and neglect. Trauma Adapted Family Connections (TA-FC) is a manualized trauma-focused practice rooted in the principles of Family Connections (FC), an evidence supported preventive intervention developed to address the glaring gap in services for this specific, growing, and underserved population. This paper describes the science based development of TA-FC, its phases and essential components, which are based on theories of attachment, neglect, trauma, and family interaction within a comprehensive community-based family focused intervention framework.