Patterns of Enrollment and Engagement of Custodial Grandmothers in a Randomized Clinical Trial of Psychoeducational Interventions
| Author | Frederick Strieder,Bert Hayslip,Gregory C. Smith,Julian Montoro‐Rodriguez,Patty Greenberg |
| DOI | http://doi.org/10.1111/fare.12194 |
| Published date | 01 April 2016 |
| Date | 01 April 2016 |
G C. S Kent State University
F S P G University of Maryland at Baltimore∗
B H J. University of North Texas∗∗
J M-R University of North Carolina at Charlotte∗∗∗
Patterns of Enrollment and Engagement of Custodial
Grandmothers in a Randomized Clinical Trial of
Psychoeducational Interventions
Andersen’s (2008) behavior model was used
to investigate patterns of enrollment and treat-
ment engagement among 343 custodial grand-
mothers who participated in a randomized clin-
ical trial of three psychosocial interventions:(a)
a behavioral parenting program, (b) a cog-
nitive behavioral coping program, or (c) an
information-only condition. Treatment comple-
tion was superior to that typically found with
birth parents, even though the grandmothersand
their target grandchildren both had high lev-
els of mental and physical health challenges.
Compliance did not differ signicantly by con-
dition but was higher among grandmothers who
self-reported less positive affect, were older, and
Human Development Center, College of Education, Health
and Human Services, Kent State University,Kent OH 44242
(gsmith2@kent.edu).
∗University of Maryland School of Social Work, 525W.
Redwood St., Baltimore, MD 21201.
∗∗Department of Psychology, University of North Texas,
Denton, TX 76203.
∗∗∗Gerontology Program, University of North Carolina,
9201 University City Blvd., CHHS No. 481, Charlotte, NC
28223.
KeyWords: randomized clinical trial, treatment compliance,
treatment satisfaction.
were using mental health professionals. Treat-
ment satisfaction was highest in grandmothers
who attended more treatment sessions, reported
lower annual family income, had a health prob-
lem, and were using mental health profession-
als. The practice and policy implications of these
ndings are discussed, especially in terms of
strategies for enhancing the engagement of cus-
todial grandfamilies in futurepsychoeducational
interventions.
Shifts in child welfare policy,increased caseloads,
declines in traditional foster care homes, and
case workers’ favorable view of kin as foster
parents have made placement with relatives the
most common type of foster care when relatives
are willing and able to assume care (Dolan,
Casanueva, Smith, & Bradley, 2009). Grand-
parents often accept this role, and more than
900,000 grandparent householders provide care
to custodial grandchildren (CGCs) under age
18 in the absence of co-resident birth parents
(U.S. Census Bureau, 2011). These families are
known as custodial or skipped generation grand-
families, with equal proportions being headed
by a lone custodial grandmother (CGM) or both
grandparents. However, because less than 1%
Family Relations 65 (April 2016): 369–386 369
DOI:10.1111/fare.12194
370 Family Relations
of households are headed by a lone grandfather
(Ellis & Simmons, 2014) our focus is on CGMs.
Although CGMs and CGCs face higher risk
of mental health difculties than their age peers
in the general population (Kelley, Whitley, &
Campos, 2011; G. C. Smith & Palmieri, 2007),
no studies addressing issues of enrollment and
treatment satisfaction regarding evidence-based
interventions involving custodial grandparents
have been published. Instead, programming for
these caregivers has largely involved descriptive
studies of support groups that vary greatly
in terms of leadership and content and are
not evidence based (Littlewood, 2014). Less
common support services for this population
include warm lines, resource centers, websites,
and respite (Minkler, Driver, Roe, & Bedeian,
1993).
Little research exists that has dealt with
interventions targeting grandparent caregivers,
and that which is published does not address
questions bearing on sample recruitment,
study enrollment, and satisfaction with inter-
ventions. For example, Vacha-Hasse, Ness,
Dannison, and Smith (2000) found that, dur-
ing an 8-hour psychoeducational group, group
leaders perceived CGMs as having gained mas-
tery in such areas as parenting skills, personal
well-being, relationships, managing nances,
and exploring legal issues. Kelley and Whitley
(2003) found that a community-based interdis-
ciplinary intervention improved grandmother
caregivers’ physical health and depression.
In a separate study (Project Healthy Grand-
parents), Whitley, Kelley, and Campos
(2013) demonstrated the positive effects on
empowerment of a case management support
group/parenting skills intervention among pre-
dominantly African American grandmothers.
Smith, Dannison, and James (2013) reported on
a multisite services-oriented curriculum-based
intervention (The Second Time Around) that
focused on the enhancement of parenting skills
in custodial grandparents with attendant benets
for the grandchild (see also Dannison & Smith,
2003; A. B. Smith & Dannison, 2008). These
studies, however, lacked a control group against
which to evaluate programmatic impact. In
contrast, in a study with a randomized control
design, Hayslip (2003) found both the quality
of grandparent–grandchild relationships and
parental efcacy improved after participation
in a six-session psychoeducational program
targeting both grandparent caregiver and
grandchild-related issues bearing on raising a
grandchild. However, participants also reported
more depression and parental role strain, reect-
ing frustrations they felt in not having control
over many aspects of their own and their
grandchildren’s lives.
Given the scarcity of past evaluative interven-
tion research in this population, it is vital to know
whether custodial grandparents with elevated
need actually enroll in interventions intended for
them as well as whether they are more satised
with and likely to complete a particular type of
intervention. In this article, we report informa-
tion on 343 CGMs who participated in a longitu-
dinal randomized clinical trial (RCT) conducted
across four states in which two evidence-based
interventions were compared in regard to facili-
tating health promotion/risk reduction behaviors
beneting the mental health of CGMs and cus-
todial grandchildren alike. Although the study
was originally designed to compare the rel-
ative efcacy of cognitive behavioral therapy
(CBT), behavioral parent training (BPT), and
an information-only condition (IOC), ndings
regarding characteristics of enrollees as well as
their intervention attendance and satisfaction can
provide valuable insights on the feasibility of
conducting such research as well as participant
acceptance of the experimental conditions.
We addressed three questions that inform
future clinical research and practice with this tar-
get population:
1. What characterizes the CGMs who enrolled
in the RCT?
2. What levels of engagement, as indexed by
treatment compliance and satisfaction, were
demonstrated by CGMs?
3. Which factors are related to treatment engage-
ment?
These questions are considered from the per-
spective of Andersen’s (2008) behavioral model
of health services use. Variations of this model
have informed numerous health service utiliza-
tion studies since the 1960s, including several
on custodial grandfamilies per se (Montoro-
Rodriguez, Smith, & Palmieri, 2012; G. C.
Smith, Montoro-Rodriguez, & Palmieri, 2010;
Yancura, 2013). According toAndersen, service
use is affected by three broad characteristics: (a)
predisposing factors that directly inuence use
(e.g., as age and gender), (b) enabling resources
that assist or impede use (e.g., income and social
support), (c) and need variables (e.g., clinical
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