Emerging Issues of Custodial Grandparents in Rural Settings

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Emerging Issues of Custodial Grandparents in
Rural Settings

• Martha R. Crowther, PhD, MPH
• The University of Alabama at Birmingham
• Department of Health Behavior
• crowther_at_uab.edu
• Center for Mental Health and Aging, Scientific
  Seminar SeriesOctober 11, 2004

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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)

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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.

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Grandchildren Living in Home of Grandparents
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)

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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.

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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)

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Alabama Grandchildren Living in Home of
Grandparents with No Parent Present
U.S. Census, 2000
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Summary of Reported Reasons for Custodial
Grandparenting

• Substance Abuse
• Teenage Pregnancy
• Child Abuse
• Neglect
• Abandonment

• Death of Parent
• Parent has AIDS
• Parental Unemployment
• Imprisonment

Fuller-Thomson, E., Minkler, M., Driver, D.
(1997) Poindexter, C.C. (2004)
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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

Landry, L. (1999) Harrison, K.A., Richman, G.S.,
Vittimberga, G.L. (2000)
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Alabama Black Belt

• Alabamas 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

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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

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Alabama Counties by Percent of Population in
Poverty, 1990
Percent Poverty
lt 20
20 - 39

gt 40
Alabamas Black Belt
Camden
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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.

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Design

• A cross-sectional, case control design was
  developed to conduct in-home interviews
• Sample 200 African American grandparents
• ½ raising grandchildren
• Data collection 2 hour semi-structured
  interview
• Incentive 25.00 Walmart gift certificate/cash

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Design

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

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Design

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

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Project Implementation
HR High Resource/LR Low Resource County
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Interviewer Training Data Collection
Data Collected
CHAs Training
Low Resource County (N 1 ½)
Low Resource County (N 60)
6 CHAs Trained
High Resource County (N 3)
High Resource County (N 140)
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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

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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

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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)

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Methodological Considerations

• Range in Education
• 3rd grade level to masters degree
• lt12 72
• HS 54
• gt12 26
• Strong sense of community

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Methodological Considerations

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

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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

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Conclusions

• Alabamas 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.

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Conclusions

• Participants still coming after data collected
• Received thank you note from interviewers

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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.

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Building Collaborative Ties
Family
Community
University
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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.

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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 dont 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.

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• Thank You!