LWW/FCH FCH-D-15-00033 January 29, 2016 21:15

Grandparents Raising Grandchildren

A Synthetic Review and Theoretical Model for Interventions
Moon Choi, PhD; Ginny Sprang, PhD; Jessica G. Eslinger, PhD

The number of custodial grandparents has increased significantly over the past decade. Building on Hayslip’s
and Kaminski’s comprehensive review of the literature on custodial grandparenting, we conducted an updated
review of the literature, in particular peer-reviewed journal articles published since 2004. We have developed a
conceptual model to contribute to understanding the causes and consequences of custodial grandparenting,
using the stress-coping framework while highlighting the emerging issues related to contemporary
grandfamilies such as cultural and ethnic heterogeneity in grandfamilies. We also emphasized loss, grief, and
trauma among grandfamilies and provided the implications for effective public and community health
programs.
Key words: grandfamilies, mental health, stress and coping, trauma, violence

HE NUMBER of grandparents raising grand-
T children has increased significantly over the
past decade.1 In 2010, 7 million grandparents lived
with grandchildren younger than 18 years; among
them, 2.7 million grandparents were responsible
for the basic needs of 1 or more grandchildren—
defined as grandparents raising grandchildren.1 No-
tably, about 25% of these grandparents had a dis-
ability, and approximately 21% were identified as
living in poverty.1
Author Affiliations: Graduate School of Science and Technol-
ogy Policy, Korea Advanced Institute of Science and Technology
(KAIST), Daejeon, South Korea (Dr Choi); College of Social Work,
University of Kentucky, Lexington (Dr Choi); College of Medicine
Department of Psychiatry, University of Kentucky, Lexington
(Dr Sprang); and Center on Trauma and Children, University of
Kentucky, Lexington (Drs Sprang and Eslinger).
This project titled, “Partners in Relationship: Addressing the Needs
of Grandparents Raising Grandchildren” (G. Sprang, P.I.) is sup-
ported by the Eastern Kentucky United Methodist Health, Educa-
tion & Welfare Fund. M. Choi is supported by New Faculty Develop-
ment grants from KAIST as well as by a grant (NRF-2015018593)
from the Ministry of Education of the Republic of Korea and the
National Research Foundation of Korea. The content is solely
the responsibility of the authors and does not necessarily represent
the official views of the Eastern Kentucky United Methodist Foun-
dation, University of Kentucky, KAIST, the Ministry of Education of
the Republic of Korea, and the National Research Foundation of
Korea.
The authors declare no conflict of interest.
Supplemental digital content is available for this article. Direct URL
citation appears in the printed text and is provided in the HTML
and PDF versions of this article on the journal’s Web site (www.
familyandcommunityhealth.com).
Correspondence: Moon Choi, PhD, Graduate School of Sci-
ence and Technology Policy, Korea Advanced Institute of Science
and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon
305-701, South Korea (moonchoi365@gmail.com).
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/FCH.0000000000000097
The practice of extended family members par-
ticipating in the care and raising of children is
a long-standing cultural tradition in many parts
of the world. However, the reasons for the cur-
rent trend toward grandparent-headed households
with children are a reflection of more contemporary
problems. Caregiver substance abuse, child abuse
and neglect, intimate partner violence, and parental
incarceration exacerbate existing economic and
health problems and contribute to the need for
grandparents to become primary caregivers.2,3 The
incident of exposure to domestic violence and
child abuse is greatly increased in families where
substance-misusing caregivers are present.4 Some
states have enacted laws, making it a felony to use or
manufacture drugs in the presence of children, lead-
ing to increased incarceration of substance-misusing
parents.5 In this context, many custodial grandpar-
ents cope simultaneously with the loss that placed
them in that role such as the death or incarceration
of their adult child due to substance misuse or vi-
olence, as well as their grandchild’s grief related to
parental loss and the trauma of living in these vio-
lent or neglectful homes.6-8
Becoming a custodial grandparent has been re-
ported to result in negative health and social out-
comes, social isolation, and role overload among
older adults.6,9 Research evidence also suggests that
these kinship care arrangements with grandpar-
ents, while popular and often preferable to fos-
ter care placements, are accompanied by less psy-
chosocial support and financial assistance from
child protection agencies than other out of home
arrangements.10,11 However, the subsequent impact
of this phenomenon on the health and well-being of
the child, grandparents, and community is largely
undocumented.
In the social context wherein the heterogeneity
and instability of family structures have emerged
and increased, the needs of and programs for

120 Family and Community Health April–June 2016 ■ Volume 39 ■ Number 2

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LWW/FCH FCH-D-15-00033 January 29, 2016 21:15
M. Choi et al.
custodial grandparents have been actively discussed
both in academia and society. Notably, in 2005,
Hayslip and Kaminski did a comprehensive review
of the literature on grandparents raising grandchil-
dren over the previous 15 years and pointed out
some important challenges for practitioners and re-
searchers. They highlighted the critical need for par-
enting skills training, support groups, and programs
to reduce barriers to medical, legal, and financial
assistance services among custodial grandparents.
Since 2005, a large volume of literature on grand-
parents raising grandchildren has appeared. Much
of the extant literature emphasizes issues in the con-
temporary cohort of custodial grandparents, such
as unique mental health service needs as well as di-
versity and complexity in social, cultural, and eth-
nical backgrounds among current grandfamilies. A
notable gap in the literature is the effect of vio-
lence and other types of trauma exposure on grand-
families, and the need for interventions targeting
trauma, loss, caregiver substance use, and child mal-
treatment that face many contemporary custodial
grandparents and their grandchild. To address the
knowledge gaps and emerging issues for grandpar-
ents raising grandchildren, this forum article aims
to (a) provide a synthetic review of the literature
on grandparents raising grandchildren since 2004,
(b) apply a theoretical framework of stress coping
to understand service needs and utilization, (c) pro-
vide implications for interventions, specifically tar-
geting trauma and loss, and (d) discuss potential im-
plementation in real-world settings, considering the
heterogeneity in grandfamilies.
LITERATURE SEARCH
Hayslip and Kaminski6 conducted a comprehen-
sive review of the literature on grandparents rais-
ing grandchildren. Building on their work, we
conducted an updated review of the literature,
with a particular focus on peer-reviewed jour-
nal articles published since 2004. A comprehen-
sive literature search was performed using PubMed
and EBSCO host that included the databases of
Academic Search Premier, MEDLINE, Psychology
and Behavioral Sciences Collection, PsycInfo, So-
cial Work Abstracts, Ageline, and the Sociologi-
cal Collection, with the assistance of a research
librarian. We used the following search terms:
“grandparent(s) as parent(s),” “grandmother(s) as
parent(s),” “grandfather(s) as parent(s),” “grand-
parent(s) raising grandchild(ren),” “grandmother(s)
raising grandchild(ren),” “grandfather(s) raising
grandchild(s),” “kinship care and grandparent(s),”
“kinship care and grandmother(s),” “kinship care
and grandfather(s),” “custodial grandparent(s),”
“custodial grandmother(s),” and “custodial grand-
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Grandparents Raising Grandchildren 121
father(s).” The search was restricted to the litera-
ture published from January 1, 2004, and written in
English. A total of 134 journal articles were selected
for full-text review on the basis of the inclusion cri-
teria of (a) peer-reviewed journal publication and
(b) subject matter pertaining to grandparents as pri-
mary caregivers of grandchildren (ie, grandparents
raising grandchildren) in the United States (see Sup-
plemental Digital Content Appendix I, available at
http://links.lww.com/FCH/A6).
SEARCH RESULTS
A broad range of topics were identified among
the selected texts. Two reviewers (J. Eslinger and
M. Choi) categorized 134 articles into 9 primary
and 5 secondary groups by topics (see Table). Pri-
mary categories pertain to the main foci of articles,
and secondary categories include specific popula-
tion (eg, ethnic minorities) or background of grand-
parenting (eg, family history resulting in grandpar-
enting such as military deployment). For example,
the article by Ross and Aday12 on stress and coping
in African American grandparents was categorized
into the primary group of “well-being of grandpar-
ents” and the secondary group of “African Amer-
ican grandparents.” In this way, we were able to
identify journal articles addressing a specific demo-
graphic population or those who may have special
service needs, which provide implications for pro-
grams and policies.
The construct of “well-being of grandparents”
was most studied and had the largest number of
journal articles. The well-being of grandparents in-
cluded health status,13,14 depressive symptoms,15,16
caregiver stress,12,17 and emotional strain.18 The
category of “services for grandparents” included
22 journal articles, which focused on evalua-
tion of service programs, discussion of current
programs, or service needs. Many articles were
categorized under the broadly defined “others”
category, indicating the varied scope of inquiry
about grandparents raising their grandchildren. Ar-
eas of study within this category included policy and
service implications of grandparents raising their
grandchildren,6,19,20 proposed theoretical concep-
tualization to help understand grandfamilies,16,20,21
the identification of risks and benefits for parent-
ing grandparents,16,22,23 and cultural implications
related to grandparenting.24-27
PRIMARY FINDINGS OF THE LITERATURE
REVIEW
The primary findings of this review are 2-fold.
First, there are increasing needs and diversity among
custodial grandparents—especially related to eth-
nicity and gender of custodial grandparents. The
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122 Family and Community Health
TABLE. Categories of Journal Articles by Topics
Number of
Primary Category Articles
Well-being of grandparents 40
Services for grandparents 22
Policies and laws 17
Relationships between grandparents and 11
their grandchildren
Parenting skills of grandparents 4 Child with special conditions
Health and achievement of grandchildren 4
Communication between grandparents 2
and their grandchildren
Training health professionals working with 2
grandparents
Others 32
presence of parenting grandparents in society is
on the increase, and this occurs through a vari-
ety of pathways.28,29,30 However, formal policies
and services for grandparents—especially in the
areas of concrete and financial services—remain
an area of need.19,23,31-35 While grandfamilies are
found across all cultural and ethnic backgrounds,
we need to pay special attention to the care needs
among African American and other ethnic mi-
nority grandfamilies.12,16,18,24,25,30,36-39 In addition,
much of the existing literature has focused on the
caregiving needs and experiences of grandmothers
with less attention on the needs and experiences of
grandfathers.15,18,22,23,26,34-37,40-44
Second, grandfamilies go through the highly
stressful “process” of care and role changes influ-
enced by various stressors.29 For example, the expo-
sure to substance abuse, parenting instability, mal-
treatment, neglect, and loss prior to placement into
a grandparent’s care can lead to emotional, be-
havioral, and academic difficulties for children in
grandfamilies.45 The acceptance of the parenting
role can lead to substantive shifts in the grandparent
and grandchild relationship.46,47 Being a grandpar-
ent raising grandchildren often results in changes
in their adult relationships, financial stability, and
physical and emotional health.14,15,18,48,49
Points of interest
We highlighted the issues that have received the
most attention in the peer-reviewed journal articles
published since 2004 in the following section. We
also discuss the implications of these issues on devel-
oping and providing social and health services for
grandfamilies.
Formal and informal social support
The role of social support in the well-being of
grandparents raising their grandchildren has contin-
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
April–June 2016 ■ Volume 39 ■ Number 2
Number of
Secondary Category Articles
African American grandparents 19
Other ethnic minorities 12
Family history resulting in grandparenting 6
Grandfathers parenting grandchildren 5
1
ued to be an area of focus in the literature for the
past 10 years. The review by Hayslip and Kaminski6
addressed unmet needs for social support and iden-
tified loneliness as a problem experienced by cus-
todial grandparents. Recent research has also re-
ported that grandparents feel socially isolated from
same-age peers, and parenting their grandchildren
often makes it difficult to find the time to spend
with intimate partners.13 In addition, formal and in-
formal support has been found to reduce negative
outcomes from stress on the well-being of grand-
parents raising their grandchildren.17,50 The pres-
ence of formal social support for grandparents ap-
pears to be helpful, particularly in reducing certain
types of caregiver stress. For example, Gerard and
colleagues50 found formal support to be protec-
tive of parenting stress associated with parenting
a grandchild with health problems. Social support
has been also found to be positively correlated with
physical health status.14 However, further research
is needed to fully understand the relationships be-
tween aspects of social support and types of par-
enting stress, such as stress related to grandchild or
grandparent health, isolation from peers, and finan-
cial difficulties.
Cultural sensitivity and awareness
Similar to the findings of the review by Hayslip
and Kaminski,6 recent studies have reported that
ethnic minority families in the United States often
have high rates of custodial grandparents. For ex-
ample, Mexican American grandparents older than
45 years are 4 times more likely to be grandparents
raising grandchildren than non-Hispanic whites.25
In addition, the findings from previous studies about
ethnic minority grandparents have helped identify
different needs among ethnic minority groups. For
example, Asian American grandparents providing
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M. Choi et al.
primary care for a grandchild are more likely to be
younger and female than nonparenting Asian Amer-
ican grandparents.51 Native American grandfami-
lies more often seek out support services through
their Tribal Nations or through Native American
urban agencies as opposed to national—or state-
funded programs.38 Adherence to cultural tradi-
tions has been reported to be particularly impor-
tant among Native American grandparents raising
grandchildren.52 These findings reinforce the impor-
tance of considering the differing cultural perspec-
tives in developing services and programs for grand-
parents raising grandchildren.
New areas of research
Since the review by Hayslip and Kaminisk,6 sev-
eral new areas of study have emerged. Relationships
between grandparents and their grandchildren have
been increasingly examined; by and large, grandpar-
ents and their grandchildren have reported feeling a
close emotional bond to one another.46,53 Goodman
and Rao53 found that 83% of children raised by a
grandparent reported feeling emotionally close to
their caregiving grandparent. However, emotional
and behavior problems of the child, in addition to
stressors such as financial difficulties, were found
to interrupt a grandparent’s feelings of emotional
closeness with his or her grandchild.46 In addition,
Poehlmann and colleagues54 found that children
were more likely to exhibit acting out behaviors
when they perceived a lack of responsiveness from
their caregiving grandparent.
Research has also begun to focus on formulating
a better understanding of how the transition from
grandparent to parenting grandparent may affect
levels of stress and well-being. Previous research has
reported elevated levels of stress associated with be-
coming a primary caregiver of a grandchild among
older adults.13,14,17,43,48,50 Grandparents, who are
newcomers to the parenting role, would be at higher
risk for negative health outcomes than experienced
grandparents.15 However, grandparents who cared
for their grandchild for longer periods of time re-
port more positive levels of well-being than their
newer counterparts.15 These findings suggest that
the shift in the role from grandparent to parent-
ing grandparent may be a time of elevated stress for
grandfamilies.
CONCEPTUAL MODEL
The process of transition to grandparents rais-
ing grandchildren is complex, wherein multiple
factors—such as family history, relationship, and
ethnicity—influence adjustment to the custodial
role.6 It is critical to understand how these issues
affect the causes and consequences of custodial
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Grandparents Raising Grandchildren 123
grandparenting. Elucidating the components of the
process by establishing a conceptual model helps
illustrate the adaptive processes associated with cus-
todial grandparenting and, therefore, enables pro-
fessionals working with grandfamilies to develop
effective interventions that ameliorate the negative
outcomes associated with this role transition.
We developed a conceptual model of causes and
consequences of custodial grandparenting from a
stress-coping framework with a reference to the
model by Choi et al (see Figure).55 The stress-coping
approach provides an explanatory framework for
understanding the losses and adverse life circum-
stances faced by older adults and their psychosocial
and physical well-being.56 This approach can assist
with understanding how a grandchild’s exposure to
traumatic experiences, such as violence and expo-
sure to parental substance abuse, can affect grand-
parent caregiver coping and well-being. The stress-
coping framework has a well-defined structure
containing specific components such as stressors,
buffers, and outcomes,55 which helps disentangle
various factors affecting the process of transition to
be a custodial grandparent. The following sections
explain each component of the conceptual model.
Stressors leading to grandparenting
The major causes (ie, stressors) resulting in custo-
dial grandparenting are dysfunctional adult chil-
dren as parents. As noted earlier, numerous
studies28,29,48,53,57 have documented contemporary
issues that create a need for grandparents to assume
the caregiver role in a stage of life when they also of-
ten deal with emerging health, mobility, and finan-
cial challenges. Children exposed to abuse, neglect,
intimate partner violence, and other types of ad-
verse life events may experience elevations in emo-
tional and behavioral problems,58-60 which can fur-
ther complicate the caregiving relationship and in-
crease stress. Studies examining trauma exposure in
grandfamilies have found that up to 72% of grand-
parents are caring for a grandchild who has experi-
enced at least 1 type of trauma exposure.61
Coping with stressors
Coping behavior is activated by stress appraisal
and represents an individual’s attempt to manage
the psychological demands of a situation. Cop-
ing involves 2 co-occurring processes—attempts to
manage the social environment through problem
solving (problem-focused coping) and the regula-
tion of emotions (emotion-focused coping).62 A re-
ciprocal and dynamic relationship exists between
stress appraisal and coping, providing multiple
opportunities for the individual to try new strate-
gies or learn new skills.
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124 Family and Community Health April–June 2016 ■ Volume 39 ■ Number 2

Figure. A conceptual model of the causes and consequences of custodial grandparenting. This figure
illustrates elements of grandparenting such as stressors, coping, outcome, and buffer using the stress-
coping framework.

This model of coping may be instructive in
understanding how grandparents respond to the
perceived stress of raising their grandchildren.
For example, a grandparent may discover that his
or her adult child is abusive toward his or her
grandchildren and in jeopardy of losing custody of
the children during a child protection investigation.
The grandparent may offer to provide a temporary
relative placement, believing this to be the best way
to ensure the safety and well-being of his or her
grandchildren (appraisal). The grandparent may
feel considerable anger and disappointment toward
his or her adult child’s behavior but suppresses
these feelings when interacting with all concerned
parties to facilitate a smooth transition for the
grandchildren (emotion-focused coping). Caring
for children who may be emotionally and physi-
ologically dysregulated by their life experiences is
especially challenging within this context and may
require the grandparent to acquire new or modified
adaptive strategies to create and maintain indi-
vidual and family stability. For example, once the
placement is secure, the grandparent may actively
seek out respite services to manage the stress of full-
time caregiving, secure mental health counseling for
the children to help them deal with the loss of their
primary caregiver and heal from the trauma related
to the abuse, or learn new parenting techniques
to manage problem behavior (problem-focused
coping).
According to Lazarus and Folkman,62 coping be-
havior is situational and varies on the basis of con-
text. In this regard, the utility of any coping strategy
is enhanced when selected on the basis of the grand-
parent’s understanding of (a) his or her role and re-
sponsibility, (b) accuracy of the projected outcome
of a particular coping behavior, (c) how the strat-
egy might be interpreted by grandchildren or the
individual’s adult children, and (d) the acquisition
of the requisite knowledge and skills to address the
life experiences of the child.63
Outcomes of grandparenting
Hayslip and Kaminski6 noted many negative per-
sonal, interpersonal, and economic consequences to
custodial grandparenting, as well as poorer physical

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LWW/FCH FCH-D-15-00033 January 29, 2016 21:15
M. Choi et al.
and mental health among older adults. These neg-
ative outcomes can occur if the level of stress ex-
ceeds the grandparent’s capacity for self-regulation
or problem solving. Recent studies have docu-
mented these negative outcomes. For example, cus-
todial grandparents tend to experience the nega-
tive consequences in psychosocial well-being such
as loss, grief, depression, loneliness, isolation, dis-
ruption of social activities, alternations in family re-
lationships, increased level of stress, and financial
difficulties.13,15,48 Custodial grandparenting is also
associated with negative outcomes in health status
and behaviors such as the suppression of preventive
behavior.15
Buffer for the negative consequences
of grandparenting
The majority of studies on interventions for
custodial grandparents published over the past
decade have focused on evaluating programs tar-
geting the practicalities of custodial caregiving
and helping cope with daily parenting strug-
gles such as access to care, self-care, interface
with service systems, and social-emotional support.
Tested and evaluated interventions include case
management approaches,64,65 support groups and
services,40,66-68 empowerment programs,33 parent-
ing programs,66,69,70 and physical activity and nutri-
tion programs.71 While the methodological designs
for these studies range from focus groups to longi-
tudinal pre- and posttest designs, each of these in-
vestigations has documented positive results for the
intervention group in terms of their customer sat-
isfaction, attendance, and self-reported benefit (eg,
symptom reduction).42,64,68,69
Other sociodemographic factors
Previous studies have reported that gender and eth-
nicity of older adults play an important role in the
process of becoming custodial grandparents. Eth-
nic minority older adults are more likely to become
grandparents raising grandchildren than their non-
minority counterparts.39,72 In addition, there is in-
creasing attention on custodial grandfathers who
would have different challenges and service needs
compared with custodial grandmothers.23,36 In gen-
eral, a grandparent’s gender, ethnicity, and cultural
or social status may impact their appraisal of stress,
their expression of emotion, and the availability and
utilization of strategies to buffer or ameliorate the
stress. The findings of previous studies imply the im-
portance of sociodemographic characteristics and
cultural perspectives in understanding the causes
and consequences of custodial grandparenting and
also developing and delivering effective social ser-
vices to grandparents.
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Grandparents Raising Grandchildren 125
Implications for practice and policy
A number of programmatic and policy initiatives
have been implemented to address structural prob-
lems associated with access to care and benefit eq-
uity and availability to custodial grandparents and
grandchildren. In 2000, the National Caregiver Sup-
port Program was established to enhance states’
ability to provide a comprehensive array of services
(eg, information, support services, financial, legal,
and therapeutic programs) to these grandfamilies.
As an access and resource provision intervention,
this program was the impetus for the development
of microinterventions to address specific caregiving
problems. In a parallel process, public benefits pro-
grams such as Supplemental Security Income, Old-
Age Survivors and Disability Insurance, Temporary
Assistance to Needy Families, and Medicaid and
the Children’s Health Insurance Program were ex-
panded to provide financial assistance and medical
insurance to children younger than 18 years. These
advances have set the stage for a generation of tai-
lored interventions to address the needs of diverse
grandfamily constellations.
Previous studies evaluating programs targeting
grandfamilies such as case management approaches
and support groups have provided evidence of pos-
itive results of those interventions.42,64,68,69 How-
ever, there were no studies identified over the past
decade that examined the efficacy or effectiveness
of interventions aimed at addressing the issues of
trauma, loss, caregiver substance use, and child
maltreatment that face many contemporary custo-
dial grandparents and their grandchildren. Care-
giver substance abuse, child abuse and neglect, in-
timate partner violence, and parental incarceration
all contribute to the need for kinship care.12,73,74
In this context, many custodial grandparents cope
with loss, such as the death or incarceration of their
adult child. The grandchildren may suffer as well
from grief related to parental absence and their
ongoing reactions to neglectful or abusive caregiv-
ing in their biological parent’s home.6,75 Further-
more, relational interventions for these families fo-
cus primarily on parenting skill development for the
grandparent. Notably absent from the current lit-
erature are approaches to improve the quality of
the relationships between these dyads, a significant
dilemma, given the importance of healthy caregiver-
child attachments in buffering the effects of child-
hood adversity.76
A recent article by Strong and colleagues75 de-
scribes an intervention model based on a trauma,
attachment, and family therapy framework. Expo-
sure to traumatic events (eg abuse, violence) may
overwhelm the child or adult’s capacity to cope,
such that their usual adaptive strategies may be
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126 Family and Community Health
insufficient to manage the overwhelming affect and
cognitive disruption introduced by the traumatic
stimuli. This model advances the work of prior ap-
proaches by shifting the focus of the intervention
from parenting skill development to relationship
building between the grandchild and grandparent
and adaptive coping with the goal of moderating
the effects of trauma and adversity on the family.
Unfortunately, this specific model remains untested,
although evidence-based, relational approaches (ie,
Child Parent Psychotherapy) targeting biological
parents and young children (0-6 years of age) have
been established.77 Because of the paucity of in-
tervention research involving discrete grandparent
samples, it is important to consider and evaluate ex-
isting evidence-based treatment approaches that tar-
get the specified needs of these families that may be
similar to other groups (eg, biological families). In
this way, opportunities to adapt existing best prac-
tices protocols or the need to develop new interven-
tions to address the trauma, loss, and attachment
problems of custodial grandparents and grandchil-
dren can be identified. Trauma-Focused Cognitive
Behavioral Therapy is one example of an interven-
tion that has been found to be efficacious for the
treatment of child traumatic stress in various fam-
ily constellations.78
To maximize effectiveness, not only must inter-
vention services be tailored to the needs of the
grandfamily constellation, these approaches must
be tested on the basis of representative samples and
real-life conditions. Unfortunately, intervention re-
search for this population is in its infancy and is
plagued by methodological problems such as (a)
overreliance on small, convenience samples that do
not reflect the heterogeneity of the custodial grand-
parent population, (b) the exclusion/lack of grand-
fathers in target groups, and (c) ambiguous treat-
ment goals and foci.
CONCLUSIONS
The current state of the literature suggests that the
prevalence of grandparents raising grandchildren
is on the rise. High levels of stress and negative
emotional and physical health outcomes have been
found among parenting grandparents. The shift in
role from grandparent to parenting grandparent can
be difficult for families and can affect both the
grandparent-grandchild relationship and the grand-
parent’s relationships with other adults. Further-
more, epidemiological data document a trend to-
ward grandparenting at a younger age as well as
increasing diversity in the needs and profiles of cus-
todial grandparents. Experiences of financial hard-
ship are pervasive for grandfamilies across cultural
and ethnic groups, and a substantial need exists for
Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
April–June 2016 ■ Volume 39 ■ Number 2
the development of both formal and informal mech-
anisms of support for these families. These emerging
social phenomena transform the need and nature of
caregiving disruptions.
Formal supports are needed to address the varied
facets of the child and grandparent’s experiences
within the grandfamily. A public health model of in-
tervention can be useful in this regard by identifying
the need for remediation at the societal (influencing
policy and legislation and changing organizational
practices), community (fostering coalitions and
networks and educating providers and community
members), and individual (strengthening individual
knowledge and skills) levels.79 Coordination of
such a complex architecture of services requires
deliberate planning and an organizing force. Pro-
fessionals working with grandfamilies can act as
boundary spanners80 to coordinate and enhance
service delivery in ways that improve access to care,
create equity in service provision, and strengthen
this contemporary family structure. Interventions
must include financial and caregiving supports,
as well as mental health service provision that is
aimed at addressing the emotional needs of children
who may have been exposed to abuse and neglect,
parental substance abuse, and the sudden loss of
the child-parent relationship prior to placement
with their grandparent.
REFERENCES
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