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

Abstract

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

Harnessing the Power of Positive Parenting to Promote Wellbeing of Children, Parents and Communities Over a Lifetime

“…Furthermore, parenting programs have been shown to be useful with parents who have serious mental health problems such as depression and bipolar disorder (Calam & Wittkowski, 2017; Sanders & McFarland, 2000), high levels of couple conflict over parenting and marital breakdown (Stallman & Sanders, 2014), and parents with histories of domestic violence, substance abuse and homelessness (Haskett, Armstrong, Neal, & Aldianto, 2018). Parenting programs can also have a multigenerational benefit, as illustrated by trials of Group Triple P with both custodial and non-custodial grandparents (Kirby & Sanders, 2014; Smith, Hayslip, Hancock, Strieder, & Montoro-Rodriguez, 2018).…”

“…As adults transition into other stages of life (e.g., becoming a grandparent) they can still benefit from participation in parenting programs (Kirby & Sanders, 2014). Smith et al (2018) in an RCT involving custodial grandparents that compared EBPS (Group Triple P), CBT and care as usual, found that both Triple P and CBT improved the grandparents’ wellbeing and reduced behaviour problems in grandchildren. Furthermore, differences in roles and expectations of grandparents based on cultural differences can create additional sources of both support and conflict.…”

“…The so-called ‘sandwich’ generation of parents who have ageing parents, and adolescent children or adult children and grandchildren (‘club sandwich’ generation) enter a new phase of parenting where the joy of grandparenthood can occur but also the stress of undertaking multiple caring responsibilities. Apart from recent studies evaluating the effects of parenting programs with grandparents (Kirby & Sanders, 2014; Smith et al, 2018) and some work with separated or divorced parents (Stallman & Sanders, 2014), relatively little attention has focused on preparing parents to manage other major life transitions and disruptions. From an intervention perspective, the delivery of programs can be disrupted by life events of families and these events can change over the course of an intervention.…”

The Utility of Solution-Oriented Strategies to Support Grandparents Raising Grandchildren

“…Most interventions to support grandparent caregivers have adopted a stress and coping framework, emphasizing such constructs as resilience or resourcefulness (Choi et al, 2016;Musil et al, 2019) or employing a family-stress model (Smith et al, 2018). A recent meta-analytic review (Chan et al, 2019) concluded that interventions for grandparent caregivers do have positive effects concerning various well-being-related outcomes.…”

“…A recent meta-analytic review (Chan et al, 2019) concluded that interventions for grandparent caregivers do have positive effects concerning various well-being-related outcomes. Relying on the family-stress framework, Smith et al (2018) found both parenting skills and cognitive-behavioral programs to be superior to a nonskill-based control (social support) condition in positively impacting grandmothers' well-being and their grandchildren's emotional/behavioral outcomes. The salience of such work is underscored by research suggesting that while grandparents' relationships with grandchildren are associated with positive well-being, this is not the case when they engage in extensive childcare or caregiving responsibilities (Thomas et al, 2020).…”