GRANDPARENTS RAISING GRANDCHILDREN IN SHREVEPORT, LA: CHALLENGES AND RESOURCESLISH’A BOND

FROM THE PRACTICUM

Literature search concerning grandparents raising their grandchildren

Literature review concerning grandparents raising their grandchildren

Developed a matrix for collecting and analyzing data

Searched MLK Health Center data base to determine which patients are grandparent caregivers

Identified resources for health and well-being available currently to grandparent caregivers in Shreveport, Louisiana

Created a matrix for the community resources identified

Listened to and read the transcripts of 11 of Dr. Clottey’s previous interviews of grandparents raising grandchildren

Read selective chapters from Siedman’s book on qualitative interviewing

Read Designing Qualitative Research

Constructed appropriate qualitative interview questions with faculty supervisor and practicum supervisor

Piloted four interviews

PROBLEM

United States

2.9 million grandparents raising grandchildren in 2009

5% of all children

Louisiana 2010 census

11.5% (128,600) of children lived with grandparent householders

72,555 cared for primarily by the grandparent

26,708 had no parent present

68,668 grandparents raising grandchildren in their home

46% have no parent present

27% live in poverty

In Shreveport, LA 2,593 grandparents “are the householders and responsible for their grandchildren living with them.”

SIGNIFICANCE

Circumstances leading to grandparent caregivers

Substance abuse

Death

Child abuse, neglect, or abandonment

Divorce

Teen pregnancy

Unemployment

HIV/AIDS

Incarceration

Physical/mental/developmental illness

Financial or emotional hardship

SIGNIFICANCE

Grandchildren's increased health risks

Developmental delay

Emotional issues

Psychological and behavioral problems

Poor physical health

Asthma, weakened immune system, physical disabilities, poor sleeping patterns, sinuses, allergies, chronic bronchitis, poor eating habits, and diabetes.

SIGNIFICANCE

Grandparent’s increased health risks

Mental health

Stress, depression, psychological distress, anxiety, and stigma related to the grandchildren’s parents

Social health

Role functioning, social isolation, role conflicts, marital distress, dysfunctional parenting, role restructuring, social functioning, and family dysfunction

Physical health

Diabetes, hypertension, heart disease, insomnia, overweight or obesity, activity limitation, body pain, decreased physical functioning, and suppressed immune function

Other concerns

Quality of life, caregiver burden, poverty, legal issues, and adequate resources and services

QUALITY OF LIFE

Negative

Decreased mental and physical health

Positive

Provides a second chance and new opportunities

Predictors of quality of life

Education level

Number of grandchildren being cared for

Grandchildren’s health problems

CAREGIVER BURDEN AND SERVICES

“Burden uniquely predicted needs for information about services, needs for service, and service use.”

Awareness of a need for services and what services are available is vital to help support grandparents raising grandchildren.

Reasons for being unaware of services

Lack of access

Distrust of the services

Greater family resources

Depression

Recommendations made by the study

Utilizing faith-based organizations

Support groups

Reducing barriers

METHOD

Qualitative Research

Exploratory or descriptive

Stresses importance of context, setting, and subjects’ frame of reference

Preserve right to modify aspects of research design as research proceeds

Pilot study may be important

Qualitative procedures criteria

Informational adequacy

Efficiency

Ethical considerations

METHOD

Site of Study: Martin Luther King Health Center

The mission is to serve at no cost to uninsured patients with chronic illness who would forgo routine medical care because of a lack of resources to reduce health costs by lowering the number of unnecessary hospital emergency department visits.

Patient eligibility

Age:18-64

Uninsured

Not above 200% poverty

One or more chronic illnesses

Entry

Dr. Dennis Wissing

History of MLK and the MPH program

METHOD

Participant Population

Charts for each clinic were viewed to determine if the clients had minors in the household

If so, they were approached and asked if they were a grandparent raising their grandchild

If so, they were asked to participate in the interview

Clients who did not have minors in the household on their charts were approached, asked if they were a grandparents caring for their grandchild, and then asked if they were willing to participate in the interview

If the client agreed they were brought to a private conference room to conduct the interview in a confidential manner

METHOD

Data Collection

Primary

In-depth interviews recorded audibly

Supplemental

Unobtrusive client chart reviews

INTERVIEW QUESTIONS

Practicum Interview Questions Lish’a Bond

Interview Questions (10-20 mins):

1. May I ask why you are here today?

2. How old are the grandchildren you care for?

3. How long have you been caring for them?

4. Do your grandchildren have health insurance?

5. Do your grandchildren see a doctor? If so, would you mind telling me about

that?

6. Are you aware of services in the area for grandparents raising grandchildren?

7. What services or resources do you currently receive to help raise them?

8. Are you aware of any groups in the area for grandparents raising grandchildren?

If so, do you belong to a social support group for grandparents raising

grandchildren? If not, would you find a support group helpful for you?

9. What happened for you to take responsibility for your grandchildren’s care?

10. Do you have legal custody of your grandchildren?

11. What are the difficulties or frustrations you face with raising your

grandchildren?

12. What is the most fulfilling about raising your grandchildren, or what do you get

out of it that is good?

13. What resources do you think would be helpful in raising your grandchildren?

14. Would a resource information pamphlet or booklet, with information on who

provides, where they are located, and how to receive the resources, be helpful to

you?

15. Would a resource center for grandparents raising grandchildren be useful to

you?

DEMOGRAPHIC AND OTHER DATA COLLECTED

Age

Sex

Race

Marital status

Health conditions

Health insurance

Educational level

Employment status

Yearly income

Source of income

ETHICAL CONSIDERATIONS

Data from chart reviews labeled with a coded number prohibiting identification of subjects’ name

One-on-one interviews audibly recorded with no mention of names

Recordings and transcriptions coded as well to prevent participant identification

DATA ANALYSIS

Interviews

Themes and coding

Descriptive analysis

Chart Reviews

Descriptive analysis

RESULTS

Data on 15 participants extracted from their MLK patient charts

One recruit declined participation

Ages of the participants ranged from 42-70 and the mean age was 57

Participants were primarily female, black, married or divorced, and had completed 12th grade

RESULTS

Most Common Health Conditions

High blood pressure

Arthritis

High cholesterol

Diabetes

Other common health conditions: stroke, asthma, and depression

Most participants had no health insurance

No health insurance and denied by Medicaid

RESULTS

Yearly household income ranged from $864 to $31,536 with a mean of $16,637

Most common sources of income were wages and disability

Many had more than one source of income

Wages and a household members’ disability

Wages and a household members’ social security

Social security and pension

RESULTS

15 participant interviews

One participant spoke Spanish only

Daughter-in-law answered the questions she knew and translated the ones she did not

RESULTS

24 total grandchildren of the 15 grandparent caregivers

Grandchildren’s age ranged from 1 to 18 years with an average age of 9 years

Grandparent caregivers cared for 2 grandchildren on average with range from 1 to 4

10 of the 15 grandparents caregivers had been caring for them since they were born

Average time was 7 years with a range of 1 to 18 years

RESULTS

Health Status

70% stated no ongoing health issues

Health Insurance Status

>70% yes with 66% having Medicaid

Some participants said the grandchild did not have any yet followed with sating they have Medicaid

Others said the grandchild had Medicare, but corrected to Medicaid

RESULTS

Most Common Reasons

Mother working

Mother deceased

Drugs/alcohol

DCFS/CPS

Legal Custody

67% did not have full custody

13% had full custody

Joint, guardianship, and unsure

RESULTS

Most Common Challenges

Difference in activity level

Behavioral issues

Financial and lack of resources

Most Common Fulfilling

Everything, happiness

Knowing the child was learning, safe, and being raised right

RESULTS

Aware Frequency Percentage

No 12 80%

Yes

Food pantry 1 6.7%

Unable to identify 2 13.3%

Services Received Frequency Percentage

No 7 46.7%

Yes

Food stamps 6 40%

Food pantry 1 6.7%

Social Security from

deceased parent 1 6.7%

Check for autism 1 6.7%

RESULTS

Resources Needed/Wanted

Money/finance

Food

Clothes

Utility bills

Medicaid

Home improvement

Support group

Legal resource

Housing

Transportation

RESULTS

Aware of Groups

93% were not

Would Join Support Group

Yes = 53%

No = 13%

Maybe = 33%

Reasons

Time constraints

Poor health

RESULTS

Response Frequency Percentage

Information Pamphlet

Yes 12 80%

Uncertain 2 13.3%

In Spanish 1 6.7%

Resource Center

Yes 13 86.7%

No 1 6.7%

Maybe 1 6.7%

RESULTS

Suggestions

Information Pamphlets

Partial payments (home improvements)

Utility bills help

Part-time jobs

Legal help

Clothes

Food

Information on handling changes in today’s teenagers

Spanish version

Website

RESULTS

Suggestions

Resource Center

Located in Shreveport

Activities for parents with kids

Grandparents get together and do activities with grandchildren

Support groups for the grandchildren

Open weekends (Saturday mornings)

LIMITATIONS

Small sample size

Convenience sampling

Lacked control group

Single informant

BIAS

Positive response

Social desirability

Interviewer

RESOURCE INFORMATION

Directory

Director of MLK

Director of MPH program

Pamphlets

Participants, through MLK

Electronic version provided to the staff of MLK to be provided to their other clients as needed

COMMUNITY RESOURCES

Academics

Application centers

Behavioral health

Bills

Cash assistance

Child support enforcement

Clothing

Counseling

Dental care

Disaster services

Education

Employment training

Family planning

Financial assistance

Food

HIV/STI testing

Home improvement

Housing

Immunizations

Information and referral

COMMUNITY RESOURCES

Job placement

Legal

Medical care

Medical equipment

Optometry

Pharmacy

Prescription assistance

Rehabilitation and therapy

Screenings

Support groups

Transportation

Vital records

WIC

Other: phones, medical alert program, mentoring and support, sports and recreation, Haven Houses and Friendship Houses

FURTHER RESEARCH

More expansive and further in-depth research needed in Shreveport, LA to include:

Interviews with the organizations identified as community resources

Quantitative data

Support groups

Literature review found support groups are beneficial to grandparents raising grandchildren

Participants responded that they would be interested in joining a support group

Website

Collaboration and partnerships within and between community resources

Resource center

One-stop-shop to provide information, referrals, and help navigate the system of resources available