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EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
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Unbroken Circles: Insular Communities of Grandparents Raising Grandchildren in Rural America
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From the article: Whitt-Woosley, A.
, Sprang, G., & Eslinger, J.G. (in press).
Unbroken circles: Insular communities of grandparents raising grandchildren in rural America. Child Welfare.
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Outcomes for maltreated children residing in relative placement versus foster care are generally more favorable (Winkour, Holtan, & Batchelder, 2014), and child welfare policies often support relative placement as a first line approach to out of home care. However, relative caregivers, specifically grandparents raising grandchildren may find that they are involved in complex situations, caring for children with special needs while receiving limited support or financial assistance from child welfare agencies (Kirby & Kaneda, 2002; Choi, Sprang & Eslinger, 2016). Concerns regarding the national opioid epidemic and its impact on families throughout the country and particularly in the Appalachian region highlight some unique challenges to service provision with grandfamilies. Discussion of this insular population and potential reasons for underrepresentation supports the development of strategies for more effective research, practice and policy in child welfare.
What We Know About the Target Population
- In recent years, the number of grandparents acting as primary caregivers for their grandchildren has steadily increased. In the United States, 42 percent of grandparents residing with their grandchildren function as the primary caregiver, and the southeastern sector of the country has the highest density of grandparents acting as head of household (U.S. Census, 2013, 2014).
- In Central Appalachia, significantly higher rates of custodial grandparenting have been observed compared to other parts of the country (Phillips & Alexander-Eitzman, 2016). This region also contains the highest concentration of economically distressed counties, where poverty rates can be twice the national average (Appalachian Regional Commission, 2008).
- These statistics parallel emerging reports of increases in the number of children entering foster and relative care in areas affected by the growing opioid epidemic including rural western, southern and Appalachian regions of the United States (Appalachian Regional Commission, 2008; McDonald, Carlson & Izrael, 2012).
- One study (Sprang et al., 2014) found that grandparents raising grandchildren in Appalachia were significantly more likely than other grandparents to be caring for children with special mental health or medical needs and to be in the primary caregiving role due to parental substance abuse or parental incarceration. 72 percent of these children were also found to have experienced at least one traumatic exposure which indirectly affected grandparent stress.
- Appalachian grandparents were also significantly more likely to rely on Medicaid as their primary insurance, be unemployed, have less education, and be single than other grandparents. However, there were no significant differences in rates of child welfare involvement when compared to their non-Appalachian counterparts.
It appears that grandfamilies in rural or Appalachian communities may represent an insular group potentially underserved by child welfare. Rural and Appalachian cultures are often characterized by a strong sense of familialism and reliance on the family unit as the "circle that can't be broken" to manage times of personal crisis (Barron, 1977; Beaver, 1986). However, it may be that this source of resilience in combination with geographic isolation and limited resources presents challenges to service systems in terms of identifying need.
Proposed Research Methods to Capture the Unique Experiences of Grandparents Raising Grandchildren
Research can play a key role in helping us better understand the experiences of Appalachian grandfamilies affected by trauma and adversity. Suggestions for culturally sensitive research in this area include:
- Partnering with "trusted messengers" within communities, such as faith-based leaders, school personnel, or agency leaders to help increase community engagement, foster communication about project goals and outcomes, and build trust
- The use of respondent driven sampling (RDS) methods to help recruit Appalachian grandfamilies for study participation
- Researching variables that serve to potentially moderate outcomes such as potential risk factors (e.g. type of trauma exposure, trauma severity, substance use, availability of specialized mental health services) and variables that may serve as protective and/or promotive factors for these families (e.g. styles of coping, problem-solving and decision-making; attitudes toward family and qualities of attachment relationships)
- Considering different contextual variables when analyzing family norms, roles and responsibilities that are consistent with the culture
- Utilization of multi-method techniques that extend beyond quantitative measurements that may not be culturally or linguistically sensitive.
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Policy & Practice Implications
T
his paper used grandparents raising grandchildren in Appalachia as a case example for analysis, however the discussion is relevant to service provision with grandfamilies in other insular environments. Key considerations include:
- Service delivery systems for these communities should harness the social capital (e.g. sense of belonging, extended family availability) inherent in these family units towards the development of self-monitoring, self-correction, and recovery. One strategy could include community wide training of grandparent groups in a trauma-informed parenting curriculum like the National Child Traumatic Stress Network's (NCTSN), Caring for Children Who Have Experienced Trauma that would increase the grandparent's ability to detect trauma exposure and traumatic stress symptoms, advocate for and assess service options, and is culturally congruent with the socio-familial norms of these communities. In this way, custodial grandparents become partners with child welfare, versus only clients or service recipients.
- Partnerships should also be financially viable to be reasonable. Investments in federally-subsidized, preventative, guardianship programs are lacking, and the absence of financial support does little to incentivize insular groups into child welfare prevention programs or partnerships. Currently, funding for kinship care is limited, only available in certain areas of the country, and is not yet widely available in Central Appalachia. Full funding and implementation of this policy is needed.
- The state-local connections created can be used as a conduit for training and support to individuals who would otherwise be reluctant to engage with child welfare, and as a voluntary policy, it respects the family traditions that create cohesion and strength in rural communities.
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References
Appalachian Regional Commission. (2008). An analysis of mental health and substance abuse disparities and access to treatment services in the Appalachian region.
Barron, H. S. (1977). A case for Appalachian demographic history. Appalachian Journal, 4(3/4), 208-215.
Beaver, P.D. (1986). Rural community in the Appalachian South. Lexington, KY: University of Kentucky Press.
Choi, M., Sprang, G., & Eslinger, J. G. (2016). Grandparents raising grandchildren: A synthetic review and theoretical model for interventions. Family & Community Health, 39(2), 120-128.
Generations United. (2014). The state of grandfamilies in America: 2014. Washington, DC.
Hall, M. T., Leukefeld, C. G., & Havens, J. R. (2013). Factors associated with high-frequency illicit methadone use among rural Appalachian drug users. The American Journal of Drug and Alcohol Abuse, 39(4), 241-246. doi: 10.3109/00952990.2013.805761
Kirby, J. B., & Kaneda, T. (2002). Health insurance and family structure: The case of
adolescents in skipped-generation families. Medical Care Research and Review, 59(2), 146-165.
McDonald, D. C., Carlson, K., & Izrael, D. (2012). Geographic variation in opioid prescribing in
the U.S. The Journal of Pain, 13(10), 988-996.
Phillips, D. L., & Alexander-Eitzman, B. (2016). Intersections of poverty, geography, and
custodial grandparent caregiving in Appalachia. GrandFamilies: The Contemporary Journal of Research, Practice and Policy, 3(1), 3.
Sprang, G., Choi, M., Eslinger, J., Whitt-Woosley, A., & Looff, R. (2014). Grandparents as parents: Investigating the health and well-being of trauma-exposed families. Lexington, KY: University of Kentucky Center on Trauma and Children.
U.S. Census Bureau. (2013). B10051: Grandparents living with own grandchildren under 18 years in households. 2009-2013 American Community Survey Five Year Estimates. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
U.S. Census Bureau. (2014). American community survey: 2011-2013 three year summary file [Data]. Washington, DC: U.S. Census Bureau.
Winokur, M., Holtan, A., & Valentine, D. (2009). Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. Oslo: Campbell Collaboration.
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