Final Paper Grandparents Raising Grandchildren in Shreveport

Running head: GRANDPARENTS RAISING GRANDCHILDREN

Grandparents Raising Grandchildren in Shreveport, LA: Challenges and

Resources

Lish’a Bond

LSU Shreveport and LSUHSC-Shreveport

GRANDPARENTS RAISING GRANDCHILDREN 1

Abstract

The phenomenon of grandparents raising grandchildren is worldwide and has stretched into the United States. This phenomenon has been studied for some years now and has found that it is often through undesirable circumstances, such as drugs and alcohol, which grandchildren come into the care of their grandparents. Both the grandchildren and the grandparents have been found to be at increased risk for several health conditions such as psychological distress. Louisiana is not different from the rest of the world and also has numerous grandparent caregiver households. This qualitative study included in-depth interviews and unobtrusive chart reviews of fifteen participants who identified themselves as grandparents raising their grandchildren who regularly attend the Martin Luther King Health Center (MLK) in Shreveport, LA. It was found that the majority of the participants were unaware of services or resources in the area. It was also found that they were most challenged with a difference in activity level, behavioral issues of the grandchildren, and a lack of financial security and resources. Resources they stated they most needed included money, food, clothes, utility bill payments, home improvements, support groups, legal services, housing, and transportation. Information on resources in the area of Shreveport, LA was collected and provided in the form of a directory to the MLK director and in pamphlet form to the participants and any other clients at need at MLK. Quantitative studies, collaboration with organizations identified as resources, online resources, support groups, and a resource center are all promising possibilities for the future.


Introduction

The Problem and Significance

Grandparents raising grandchildren is not only an increasing

occurrence in the United States, but also throughout the world.

Westernization of countries has resulted in changing family dynamics and

elders are now relied on to take part in raising grandchildren instead of

being cared for themselves (Lo & Liu, 2009). In the United States the

increased reliance on grandparents to raise grandchildren has arisen from

such circumstances as substance abuse, death, child abuse, neglect,

divorce, teen pregnancy, unemployment, HIV/AIDS, incarceration, illness,

mental/developmental illness, financial or emotional hardship, and

abandonment (Bigbee, 2011; Brintnall-Peterson, 2009; Carr, 2012; Kelley,

2010; Kelley, 2013; Lo, 2009; National Abandoned Infants Assistance

Resource Center [AIA], 2004; Neely-Barnes, 2010; Smith, 2010; Van Etten,

2012). With other countries the cause is most often that the parents are

employed full-time and cannot be home to care for the children (Lo, 2009).

In the United States approximately 2.9 million grandparents were raising

their grandchildren in 2009, which accounted for 5% of all children (Kelley,

2013 & Van Etten, 2012). Over half of the grandparents raising

grandchildren are married according to Smith, 2010. Bigbee, 2011, noted of

the grandparents raising grandchildren “19% live in poverty, 67% are

younger than 60, and 25% have a disability.” In Louisiana, according to the

2010 Census, 11.5% (128,600) of children lived with grandparent


householders. Of these children 72,555 were cared for primarily by the

grandparent and 26,708 had no parent present. In Louisiana there are

68,668 grandparents raising grandchildren in their home, 46% of which

have no parent present, 68% are under age 60, and 27% live in poverty. In

Shreveport, LA 2,593 grandparents “are the householders and responsible

for their grandchildren living with them.” (AARP, 2011).

Grandparents raising grandchildren presents many unique public

health concerns and challenges. It has been found that substance abuse of

the parents can cause developmental, emotional, and psychological issues

in the children. Grandchildren being raised by grandparents have been

found to be at increased risk for developmental delay, emotional issues,

psychological and behavioral problems, and poor physical health Physical

health problems include asthma, weakened immune system, physical

disabilities, poor sleeping patterns, sinuses, allergies, chronic bronchitis,

poor eating habits, and diabetes. Other issues noted in various studies

included having three or more concurrent socioeconomic risks ,having low

or very low food security resulting in hunger, and being exposed to illegal

alcohol and drugs and engaging in unprotected sex. (AIA, 2004; Carr, 2012;

Bigbee, 2011; Brintnall-Peterson, 2009; Cornelius, 2009; Higgins, 2010;

Kelley, 2010; Kelley, 2013; Neely-Barnes, 2010; & Smith, 2010).

Grandparents caring for grandchildren have been found to bear many

different problems as well. Grandparents are often dealing with a limited

income presenting them at below the poverty level. Issues have presented


for grandparents raising grandchildren in all areas of life including mental

health, social health, and physical health, specifically chronic disease. The

most prominent mental health issue experienced by grandparents raising

grandchildren is stress, but others include depression, psychological

distress, anxiety, and the stigma often related to the grandchildren’s

parents. Role functioning, social isolation, role conflicts, marital distress,

dysfunctional parenting, role restructuring, social functioning, and family

dysfunction are all social health issues addressed in multiple studies of

grandparents raising grandchildren. Chronic disease is a focus of

grandparents raising grandchildren and includes diabetes, hypertension,

heart disease, insomnia, and overweight or obesity. Other physical health

issues include activity limitation, body pain, decreased physical functioning,

and suppressed immune function. Less common issues noted in the current

body of literature included a lack of social and family support, low food

security, lack of access to healthcare, the grandchildren’s special needs,

being ill-prepared for sexual communication, and feelings of loss, anger,

and guilt for the grandchild’s parent. (AIA, 2004; Bigbee, 2011; Brintnall-

Peterson, 2009; Carr, 2012; Cornelius, 2009; Higgins, 2010; Kelley, 2010;

Kelley, 2013; Lo, 2009; Neely-Barnes, 2010; Smith, 2010; & Van Etten,

2012).

Associated Issues

Studies have been conducted on a variety of issues caused by the

above mentioned whole health concerns. The topics to be briefly discussed


are psychological distress, dysfunctional parenting, quality of life, and

caregiver burden. Psychological distress was addressed in the study by

Kelley (2013) and utilized the resiliency model of family stress, adjustment,

and adaptation. The study found “that nearly 40% of participants [African

American caregiving grandmothers] in the current study scored in the

clinical range on psychological distress.” The caregiving role, the

circumstances bringing the child into their care, and grandchild behavior

problems all contribute to the high level of psychological stress found.

Suggestions to help counteract this psychological distress include trauma-

focused cognitive behavior therapy, support groups, and access to

community resources. Marital distress and dysfunctional parenting, due to

the new roles of caregivers on the grandparents, can cause the grandchild

to have adjustment difficulties (Smith, 2010). The study focused on the

family stress model and determined that “(a) caregiver distress is related to

poor parenting, (b) poor parenting is related to child adjustment problems,

and (c) parenting mediates the relationship between caregiver distress and

child adjustment.” Reasons for this phenomenon include deficient

interpersonal skills of the caregiver, emotional insecurity of the grandchild,

children learning the dysfunctional behavior from the caregivers, and social

and economic disadvantage. Including grandfathers in treatment, reducing

grandparents’ distress, and providing services to the grandparents when

they seek services for the grandchildren are all suggestions to improve this

phenomenon.


Quality of life in grandparents raising grandchildren has been shown

to be both positively and negatively affected. Negative effects on quality of

life include decreased mental and physical health, but positive effects

include providing a second chance and new opportunities. In one study for

health related quality of life of grandparents raising grandchildren it was

found that they were below average in physical functioning, general health,

and the physical component summary. In the same study it was found that

almost 74% of children had a health problem, most commonly asthma,

sinuses, allergies, chronic bronchitis, emotional problems, behavioral

problems, and hyperactivity. Grandparents were found to be more likely to

have symptoms of depression. Grandparents’ education level, number of

grandchildren being cared for, and grandchildren’s health problems all

predicted quality of life (Neely-Barnes, 2010). A study on grandparent

caregivers in Taiwan found very different results, there was no significant

difference in quality of life or depression symptoms between grandparent

caregivers and grandparents not responsible for the care of a grandchild.

This was the first study of this kind in Taiwan and looked to see the effects

of Westernization on grandparents in Taiwan (Lo, 2009). Caregiver burden

is another issue studied with grandparents raising grandchildren. The study

by Carr (2012) looked at caregiver burden and its relation to services

available to the grandparents to help raise their grandchildren. The study

took concepts from both the social and behavioral model of health services

and the cognitive approach to stress and coping. The study found that


“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 noted by this study

include lack of access, distrust of the services, greater family resources, and

depression. Utilizing faith-based organizations, support groups, and

reducing barriers are all recommendations made by the study.

Examples to Address the Widespread Issues

A qualitative study focused on nutrition-related practices and

attitudes found that 15.4% of seniors with grandchild in the home, but no

adult child, were food insecure while only 5.2% of seniors without

grandchildren in the home were food insecure. To address this Higgins and

Murray (2010) performed interviews and coded them to determine

reoccurring themes. These themes included being more nutrition and food-

safety conscious and shifting their child feeding style. Another theme was

the issue of an on-the-go lifestyle, sedentary lifestyle due to more screen

time, and nutritious food being expensive. It was found that the

grandparents wanted information in the form of printed or video education

materials and most wanted to learn about proper nutrition, fast foods and

packaged foods, feeding “picky eaters,” healthful recipes, and snacks low in

salt, sugar, and fat. Another qualitative study, by Cornelius (2009), utilized

focus groups to address the attitudes and feelings about sexual education

for grandparents raising grandchildren. This study was unique because it


included separate focus groups for the grandparents and the grandchildren.

This is an important topic to address because it has been found that, for

African Americans, HIV has contributed to the rising number of

grandparents raising grandchildren and “adolescent grandchildren raised

by grandmothers are more likely than children raised by their parents to

live in poverty, to be exposed to illegal alcohol and drug use, and to engage

in unprotected sexual intercourse.” The findings from these focus groups

were very promising. The grandparents knew the importance of sexual

communication and most engaged in this discussion; however, they noted

the generational differences that were not prepared for and caused them to

be uncomfortable, which was also noted by the grandchildren. Peer

pressure, media, and the glorification of sex through music and music

videos were all noted as obstacles in society to be overcome. In conclusion

of this study it was found that interventions are needed to help

grandparents learn how to have these difficult conversations with their

grandchildren. Interventions can include education, support groups,

collaboration with community and faith-based organizations, and teaching

current terminology to the grandparents. A relatively large study performed

by Kelley and colleagues (2010) examined the impact of an intervention to

improve health outcomes for grandmothers raising grandchildren. This

intervention was home-based and included visits by registered nurses and

social workers as well as education, support groups, and referrals to legal

services. For the grandchildren, early intervention services were available


for those with special needs. Goals for health concerns were made by the

grandmothers and the registered nurses. Glucometers were provided for

diabetic participants and blood pressure monitors were provided for

hypertensive participants. Measures included BMI, visual acuity, glucose,

cholesterol blood levels, blood pressure, and a health risk appraisal. The

main measure for the intervention; however, was the Short Form-36 general

Health Survey. It was found by this study that the intervention improved

physical and emotional effects on role functioning, vitality, and mental

health. A smaller project by Bigbee and colleagues (2011) provided

personalized health promotion education and behavior change

reinforcement. The project also worked as a liaison between the

participants and community resources. Measures included the Health-

Promoting Lifestyle Profile II, SF-36 Health Survey, height, weight, lipids,

blood glucose, and blood pressure at the beginning. At the end of 6 months

the HPLPII, SF-36, blood lipids, blood glucose, and blood pressure were

measured again. At the end health status was unchanged except for a

decline in diastolic blood pressure and improved nutrition. This project

could have been improved with a larger sample, a control group, and a

longer period of time for the intervention. A completely different approach

has been made and focuses on child development issues for the

grandparents raising grandchildren. This approach provided web-based fact

sheets not only for the grandparents, but also for the professionals the

grandparents come into contact with throughout their life. These fact sheets


focus on educating the grandparents on child development, close

relationships, relationship expectations, disruptions in close relationships,

importance of open communication, child behavior, children’s contact with

parents, and the cycle of family patterns. The evaluation of these fact sheets

began in their formation as they were developed and reviewed multiple

times by child and family researchers, extension specialists, and a clinical

psychologists. The fact sheets were also piloted with three groups that were

ethnically, geographically, and economically diverse. A final review was

done externally by professionals of child development, gerontology, child

welfare, and adult education. Most common changes occurring from these

pilots and reviews were simpler wording, enumeration to make the fact

sheets a series, and providing other references. Through a survey attached

to the fact sheets the value noted by their users, and themed by the

researchers, included knowledge, support, adaptability, better life, and

support for replication and modifications. The fact sheets were utilized and

found valuable by grandparents raising grandchildren, professionals who

may serve grandparents rising grandchildren, and others.

The current study’s purposes include determining the challenges of

grandparent caregivers in Shreveport, Louisiana, gathering and analyzing

data such as sex, race, and income of grandparent caregivers included in

the study, and determining resources needed and currently available in

Shreveport, Louisiana. The resources available in Shreveport, Louisiana will


be developed into a directory for organizations and brochures for

participants, as well as any other patients of the study site.


Method

Qualitative Research

Qualitative research is exploratory in nature so it was chosen for this

study as a first attempt to determine the presence of the phenomenon,

grandparents raising grandchildren, in Shreveport, LA. Qualitative research

is also descriptive in nature allowing for information to be seen in the

participants’ context, setting, or frame of reference. An important aspect of

qualitative research is its ability to be modified as needed as the research

proceeds. Many times with qualitative research a pilot study is desirable.

Site of Study

Martin Luther King Health Center (MLK) in Shreveport, Louisiana

was utilized to conduct the research study. The mission of MLK 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 criteria include an age of 18 to 64, uninsured, not

above 200% poverty, and diagnosed with one or more chronic illnesses.

Entry to MLK was possible by formal gatekeepers Dr. Dennis Wissing,

former president and current volunteer doctor, and Janet Mentasane,

current director. Dr. Dennis Wissing is a professor for the Master of Public

Health (MPH) program at LSU Shreveport/LSUHSC-Shreveport. There has

been cooperative utilization of the MLK population for the MPH program for


years now as it provides more resources and education for the patients and

research and volunteer opportunities for the MPH students.

Participant Population

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

minors in the household. If so, clients were approached and asked if they

were a grandparent raising their grandchild. If so, they were asked 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.

Other clients without minors noted in their charts were simply approached

and asked if they had grandchildren, and if so were they raising them and

willing to participate. A formal consent (appendix A) form was provided and

explained in full by the researcher prior to the interview.

A pilot study was conducted with the same participation collection

procedure and included four grandparents raising grandchildren.

Data Collection

Primary data collection included in-depth interviews consisting of

fifteen questions (appendix B). Interviews were recorded audibly for

transcription purposes. Supplemental data analysis included unobtrusive

client chart reviews with the purpose of collecting data on age, sex, race,

marital status, health conditions, health insurance status, educational level,

employment status, yearly income, and source of income.


Data from chart reviews were labeled with a coded number

prohibiting identification of the subjects’ name. One-on-one interviews were

audibly recorded with no mention of names. Recordings and transcriptions

were coded as well to prevent participant identification.

Data Analysis

Data analysis for the interviews started with the conduction of the

interviews and continued through transcription, organization, determining

themes, and coding those themes. Descriptive analysis was also utilized for

data from the interviews, as well as data from the chart reviews.

Resources in Shreveport, LA

Research to determine available resources and services for

grandparents raising grandchildren was conducted and organized in a excel

spreadsheet to include the organization’s name, address, phone number,

website, services offered, and any eligibility requirements. This information

was formatted into a directory to be used by MLK and pamphlets to be used

by the participants and any other clients of MLK who may be in need of the

services. While the resources were geared toward what was needed by the

participants and identified in the literature review, almost all of the

resources can be utilized by a myriad of populations, especially those of low

income.


Results

Chart Reviews

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 (see Table 1).


Table 1. Grandparent Caregivers Demographic Characteristics (N = 15)

Variable Frequency PercentageAge

41-45 1 6%46-50 1 7%51-55 3 20%56-60 6 40%61-65 3 20%66-70 1 7%

SexMale 1 6.7%

Female 14 93.3%Race

Black 13 87%Hispanic 1 7%

Caucasian 1 6%Marital Status

Divorced 4 26.7%Married 4 26.7%Single 2 13.3%

Separated 2 13.3%Widowed 1 6.7%

Unidentified 2 13.3%Highest Educational

10th Grade 2 13.3%12th Grade 7 46.7%

Some College 4 26.7%Associate’s Degree 1 6.7%

Unknown 1 6.7%Employment Status

Employed 6 40%Unemployed 9 60%

The most common health conditions of the participants included high

blood pressure, arthritis, high cholesterol, and diabetes. Other health

conditions found include cancer, alcohol use, carpal tunnel, heartburn

(GERD), congestive heart failure, heart failure, heart disease, and heart

failure. All of these conditions were identified by one participant each, or


6.7% of grandparents presented. Most participants had no health insurance

and several had no health insurance who had been denied by Medicaid (see

Table 2).

Table 2. Health Conditions and Health Insurance Status of Grandparent

Caregivers

Variables Frequency PercentageHealth Conditions

High blood pressure 14 93.3%Smoker 6 40%Arthritis 9 60%

High cholesterol 14 93.3%Diabetes 8 53.3%Stroke 4 26.7%Asthma 3 20%

Depression 2 13.3%Health Insurance

None 6 40%None and Medicaid 5 33.3%None and Medicaid 1 6.7%

Medicare A, B, and D 2 13.3%Medicare A, B, and D 1 6.7%

Yearly household income for the participants ranged from $864 to

$31,536 and had a mean of $16,637. The most common sources of income

for the participants were wages and disability. Many of the participants had

more than one source of income. Common combinations included wages

and a household members’ disability, wages and a household members’

social security, and social security and pension (see Table 3).

Table 3. Yearly Household Income and Sources of Income of Grandparent

Caregivers


Variable Frequency PercentageYearly Household

< $1,000 1 6.7%$1,001 - $5,000 1 6.7%

$5,001 - $10,000 1 6.7%$ 10,001 - $ 15,000 5 33.3%$15,001 - $20,000 2 13.3%$20,001 - $25,000 1 6.7%$25,001 - $30,000 2 13.3%$30,001 - $35,000 2 13.3%

Source of IncomeWages 8 53.3%

Disability 5 33.3%Social security 5 33.3%Family support 3 20%

Pension 2 13.3%Annuity 1 6.7%

Child Support 1 6.7%

Interviews

There were 24 total grandchildren of the 15 grandparent caregivers.

One participant spoke Spanish only. In this case the daughter-in-law

answered the questions she knew and translated the ones she did not. The

range of the grandchildren’s age was from 1 to 18 years and the average

age was 9 years (see Table 4).

Table 4. Demographic Characteristics of the Grandchildren (N = 24)

Variable Frequency PercentageAge

1-6 7 29.2%7-12 11 45.8%13-18 6 25%

SexMale 9 37.5%

Female 10 41.7%Undisclosed 5 20.8%


Grandparent caregivers cared for 1.6 grandchildren on average and

the number of grandchildren per grandparent caregiver ranged from 1 to 4.

When asked how long the grandparent had been caring for their grandchild

(ren) 10 of the 15 participants, 66.7%, responded since the child (ren) was

born. The average time with the grandparent caregiver for all 24

grandchildren was 7 years and the range was from 1 to 18 years. The

average time caring for the grandchild (ren) for those who had not had

them since they were born was 10 years and ranged from 1 to 15 years.

When asked if their grandchild (ren) had health insurance answers

included yes, no, and unknown. Those who said yes identified Medicaid

most often. An interesting phenomenon noted is that two grandparents who

said their grandchild did not have health insurance followed up with the

fact that the grandchild had Medicaid. Also, two grandparents claimed their

grandchild had Medicare, but when asked if it was actually Medicaid they

agreed (see Table 5).

Table 5. Health Insurance Status of the Grandchildren

Status Frequency PercentageYes

Medicaid 6 40%Medicare corrected to

Medicaid2 13.3%

Parent’s 1 6.7%No

No 1 6.7%No - Medicaid 2 13.3%


Unknown 3 20%

Most commonly grandparents identified that their grandchild (ren)

did not have any ongoing health issues requiring the child see a healthcare

provider regularly (see Table 6).

Table 6. Health Issues of Grandchildren Cared for by Grandparents

Health Issue Frequency PercentageNone 17 70.8%

Asthma 2 8.3%Overweight 1 4.2%

Epilepsy and autism 1 4.2%Eczema 1 4.2%

Seasonal allergies 1 4.2%Hearing loss 1 4.2%

One of the most common reasons for the grandparents being the ones

to care for their grandchild (ren) were the mother working. One

grandparent said,

Her momma working all the time and there nobody at home you know

to see about her. She’s trying to work and you know have something.

Another grandparent said “because the mother has to work.” One mother

works night shift so the grandparent said “Instead of waking them up,

taking them home you know I just start letting them stay with me.”

The mother being deceased was another common reason for the

grandparents having the grandchild (ren). In one situation the “…mother’s


deceased and the father is in jail.” Another grandparent said “My daughter

which was her mother passed away.”

Drugs and alcohol were involved in a couple of situations, the

daughter-in-law of one of the grandparents said

Mom was into drugs and the state took the children and we went

through court. I helped them go through court to get them.

The government was also involved in another situation as one

grandparent stated

Uhhh in Louisiana it’s called Department of Children and Family

Services. In Texas it’s called CPS. Uhh there were issues that involved

them.

A common answer also seen was that the parents were not involved or

the grandparent had asked for the grandchild (ren). One grandparent said

“Oh I just asked for her!” Yet another said “Umm they stay with me. My

daughter live with me. So I just take care of both of them.” A less common

reason was that the mother was young when she had the child and wanted

to finish school.

Most grandparents did not have legal custody of their grandchild

(ren) (see Table 7).

Table 7. Legal Custody of Grandchildren by Grandparent Caregivers

Type of Custody Frequency Percentage


None 10 66.7%Full Legal 2 13.3%

Guardianship 1 6.7%Joint 1 6.7%

Unsure 1 6.7%

One of the most common challenges for grandparents raising

grandchildren was the difference in activity level. One grandparent said

“She’s real active, I know that. She’s always tearing stuff down.” Another

grandparent said “He’s always active.” Yet another said “Activity level.

Their activity level as opposed to my activity level.”

Another common challenge for grandparents raising grandchildren is

behavioral issues and included descriptions of acting out, snapping, into

things, talking back and even the child calling the state when disciplined.

One grandparent described it as such

She getting older and now she, you know how they get, they want to

talk back and snap at you. That’s about it.” Another grandparent having

issues with the grandchild calling the state said

When she don’t want, I don’t let her maybe go and spend nights. Well

I don’t let her spend nights because the mother works; there’s nobody

there to watch her. She don’t like to do anything, but like I said I do

believe in discipline. I’m not quick on it, but I do. And she calls the

state when I do discipline her. And I’ve had them come out twice.

That’s my main problem.


Another common challenge for grandparents raising grandchildren is

financial including difficulties, lack of resources, and having only a part-time

job or no job. One grandparent said “I mean I do need to try to find me a

little part time job for something I would love to do.” Another grandparent

said “Ummm and then just general resources. There are none available as

far as I know in Shreveport.” Other challenges mentioned were scheduling

conflicts and the grandparent’s poor health.

When asked what the most fulfilling part of raising their grandchild

(ren) was the most common answers were everything and happiness. Other

common response were knowing the grandchild (ren) were learning, they

were safe and raised right, watching them grow, and listening to them. One

grandparent saying

Oh God, the most fulfilling part about that is just everything.

Everything because he’s umm loveable; he’s loveable. Wow, he’s, uh

he’s very openly and joyful, playful and he has lots of talents. Yea, lots

of talents, so its joyful with that part.

Another example is one grandparents saying

Well there is a child come up to learn and you teach different things

and education is number one and learning you know of growing up.

For a child to learn. And to raise a child the proper way. I feel like

that’s a good thing, long as the child being raised properly.


Less common responses included getting a second chance and the

grandhild’s involvement in church.

When the participants were asked if they were aware of services in

the area for grandparents raising grandchildren, most were unaware of any

(see Table 8).

Table 8. Grandparent Caregivers Awareness of Resources in Shreveport,

LA

Aware Frequency PercentageNo 12 80%Yes

Food pantry 1 6.7%Unable to identify 2 13.3%

Most participants were not currently receiving any services at the time of

the study. However, of those who were, the most common service received

was food stamps (see Table 9).

Table 9. Services Currently Received by Grandparent Caregivers

Services Received Frequency PercentageNo 7 46.7%Yes

Food stamps 6 40%Food pantry 1 6.7%

Social Security from 1 6.7%Check for autism 1 6.7%

The most common resources needed or wanted by the participants included

money or finance, food stamps, and clothes. One grandparent said “Yea,


financial like food stamps.” Another said “Some more money…you know so

we can get you know I can help daughter get clothing, feed her.” Yet

another grandparent said

I’d say just different things that they you know have needed as far as

clothing and things in school different fees and things like that.

Other resources needed or wanted included help with utility bills, Medicaid

for self, home improvement, support groups, legal resources, housing, and

transportation.

When the participants were asked if they were aware of any groups in the

area for grandparents raising grandchildren, most were unaware of any.

One participant said she was aware of one; however, she was unable to

identify it when prompted. When asked if the participants would be willing

to join a support group for grandparents raising grandchildren most agreed

that they would. Of the two who said they would not join a support group,

one said it was due to time limitations. Of the five who said maybe to join a

support group, two said it was due to time limitations and one said it was

due to health reasons (see Table 10).

Table 10. Grandparent Caregivers Awareness of Groups in Shreveport, LA

and Willingness to Join a Support Group

Response Frequency PercentageAware

No 14 93.3%Yes 1 6.7%

Willing to Join


Yes 8 53.3%No 2 13.3%

Maybe 5 33.3%

When participants were asked if a resource information pamphlet

would be useful to them most responded that it would. However two were

uncertain responding with “I think so” and “probably,” and one person

agreed that it would be useful if it were in Spanish. When participants were

asked if a resource center would be useful to them most responded that it

would. One said that it possibly would and one said that it would not be

useful to them (see Table 11).

Table 11. Grandparent Caregivers in Response to the Usefulness of

Resource Information Pamphlets and a Resource Center

Response Frequency PercentageInformation

Yes 12 80%Uncertain 2 13.3%In Spanish 1 6.7%

Resource CenterYes 13 86.7%No 1 6.7%

Maybe 1 6.7%

When the participants were asked for suggestions for either the

information pamphlets or a resource center almost half had none. However

some suggestions for the pamphlets included information on partial

payments like for home improvements, utility bills help, part-time jobs, legal

help, clothes, food, information on handling changes in today’s teenagers,


and having a Spanish version. For the resource center suggestion included

it being located in Shreveport, having activities for parents with kids,

somewhere for grandparents to get together and do activities with

grandchildren, support groups for the grandchildren, and being open

weekends, Saturday mornings specifically. Another suggestion that was

brought up was having a website that provided this information.


Discussion

Resource Information

Resource information developed into a directory and pamphlets

included sections for 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, job placement, legal,

medical care, medical equipment, optometry, pharmacy, prescription

assistance, rehabilitation and therapy, screenings, support groups,

transportation, vital records, WIC. Other less common resources included

phones, medical alert program, mentoring and support, sports and

recreation, Haven Houses and Friendship Houses. The directory was

provided to the director of MLK as well as the director of the MPH program.

The pamphlets were provided to the participants through MLK. Also, the

electronic version of the pamphlets were provided to the staff of MLK to be

provided to their other clients as needed.

Limitations

Limitations for this study include it having a small sample size,

utilizing convenience sampling, it lacked control group, and only a single

informant was utilized. The sample size included only 15 participants.

However, no new information was being attained from the later interviews;


therefore, it could be argued that for this population saturation had been

reached. Convenience sampling was utilized due to its availability and

access to entry by the researcher. Another study utilizing the same

interview questions could find very different results from another

population in Shreveport, LA. Only a single informant was utilized in this

study. More information could be attained by speaking with the

grandchildren, spouse’s, and even the organizations providing services in

the area.

Bias

Biases that could present in this study include positive response bias,

social desirability bias, and interviewer bias. Positive response bias includes

the participant answering in the way they believe the interviewer wants

them to rather than truthfully. Social desirability bias would be if the

participant did not include information about the parents being on drugs or

the government being involved because they see it as not socially

acceptable. Interviewer bias can occur if the interviewer inadvertently gives

the participant the answer in the question or if the interviewer hears only

what he/she wants to hear.


Conclusions and Future Study

In conclusion, the fifteen participants from MLK provided valuable

insight into the life of a grandparent caregiver in Shreveport, LA. It is

obvious that there are resources lacking to the participants and hopefully

the resource directory and pamphlets will begin to bridge the gap between

resources and those who need them.

While this is a start, more expansive and further in-depth research is

needed in Shreveport, LA and should include interviews with the

organizations identified as community resources as well as quantitative

data.

Support groups were identified in the literature review as beneficial to

grandparents raising grandchildren and the majority of participants in the

study responded that they would be interested in joining a support group.

Information on convenient locations and times would need to be

determined, as well as any information that the grandparents would want to

learn about or be included.

Collaboration and partnerships within and between community

resources could be beneficial for grandparents raising grandchildren.

Furthermore, a resource center, a one-stop-shop to provide information,

referrals, and help navigate the system of resources available was

supported by the participants of the study and could continue to bridge the

gap between resources and those who need them.


Another suggestion from one participant was a website that would

provide the information on resources. A website could help because most

individuals have access to computers and internet now. Also, having a

website could help with those participants who noted having time

constraints or poor health as barriers to support groups and/or a resource

center.


References

AARP. (2011). GrandFacts: State fact sheets for grandparents and other

relatives raising

children, Louisiana.

Bigbee, J. L., Boegh, B. V., Prengaman, M., & Shaklee, H. (2011). Promoting

the health of

frontier caregiving grandparents: A demonstration project evaluation.

Journal for

Specialists in Pediatric Nursing, 16, 156-161.

Brintnall-Peterson, M., Poehlmann, J., Morgan, K., & Shlafer, R. (2009). A

web-based fact

sheet series for grandparents raising grandchildren and the

professionals who

serve them. The Genterologist, 49 (2), 276-282.

Carr, G. F., Hayslip Jr., B., & Gray, J. (2012). The role of caregiver burden in

understanding African American custodial grandmothers. Geriatric

Nursing, 33

(5), 366-374.

Cornelius, J. B., LeGrand, S., & Jemmott, L. S. (2009). African American

grandfamilies’


attitudes and feelings about sexual communication: Focus group

results. Journal

of the Association of Nurses in AIDS Care, 20 (2), 133-140.

Higgins, M. M., & Murray, B. J. (2010). Nutrition-related practices and

attitudes of

Kansas skipped-generation(s) caregivers and their grandchildren.

Nutrients, 2,

1188-1211.

Kelley, S. J., Whitley, D. M., & Campos, P. E. (2010). Grandmothers raising

grandchildren: Results of an intervention to improve health outcomes.

Journal of

Nursing Scholarship, 42 (4), 379-386.

Kelley, S. J., Whitley, D. M., & Campos, P. E. (2013). Psychological distress

in African

American grandmothers raising grandchildren: The contribution of

child

behavior problems, physical health, and family resources. Research in

Nursing &

Health, 36, 373-385.


Lo, M., & Liu, Y. (2009). Quality of life among older grandparent caregivers:

a pilot

study. Journal of Advanced Nursing, 65 (7), 1475-1484.

National Abandoned Infants Assistance Resource Center. (2004). Kinship

care.

Berkeley, CA.

Neely-Barnes, S. L., Graff, J. C., & Washington, G. (2010). The health-

related quality of

life of custodial grandparents. Health & Social Work, 35 (2), 87-97.

Smith, G. C., & Hancock, G. R. (2010). Custodial grandmother-grandfather

dyads:

Pathways among marital distress, grandparent dysphoria, parenting

practice,

and grandchild adjustment. Family Relations, 59 (1), 45-59.

Van Etten, D., & Gautam, R. (2012). Custodial grandparents raising

grandchildren: Lack

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Nursing, 38

(6), 18-22.



Appendix A

Grandparents Raising Grandchildren in Shreveport, LA: Challenges and Resources

Consent Form

What is the project?

This project is a research study on the experience of grandparent caregivers in Shreveport, Louisiana. The purpose of this project is to:

Identify the challenges faced by grandparent caregivers in Shreveport, LA

Identify the resources available currently to grandparent caregivers in Shreveport, LA

Identify resources needed, which are not currently available, by grandparent caregivers in Shreveport, LA

You are being asked to participate in this project because you have been identified as a grandparent caregiver in Shreveport, LA.

What will you be asked to do for the project?

If you agree to take part in the project, you will be asked to participate in a one-on-one interview with the researcher. The interview will be recorded audibly. The interview will help determine:

The challenges faced by grandparent caregivers in Shreveport, LA The resources currently available to grandparent caregivers in

Shreveport, LA The resources needed by grandparent caregivers in Shreveport, LA

Do you have to take part in the project?

You do not have to participate in the project. Participating in the project is your decision alone. You can stop participating in the project at any point. If you do not want to participate, or decide to stop participating, you will not suffer any repercussions.

What will you get out of participating in the project?

Participation in this project is voluntary and you will not be paid.


Are there risks to taking part in the project?

Participating in this project will not put you at any risk. Participation may be uncomfortable at times due to sharing your experiences as a grandparent caregiver.

Are there any costs in taking part in the project?

The only cost for this study is in the form of giving your time for the interview.

Is what I say during the interview and focus group confidential?

The information you will share with us if you participate in this study will be kept completely confidential to the full extent of the law. Your name will not be disclosed. Any information that you will share with us will not be assigned to your name but rather it will be assigned to a number. The information you provide will be analyzed by the researcher and reviewed by research advisor Dr. Emmanuel Clottey. Study findings will be presented only in summary form to students and faculty of Louisiana State University in Shreveport Public Health Program and your name would not be used in any report.

Who is responsible for the project?

The principal investigator is Lish’a Bond, a student of the Master of Public Health program at LSU Shreveport and LSU Health Science Center Shreveport. If you have any questions about this study, please contact Lish’a Bond at 318-366-8243 or [email protected]. If you have questions about your rights as a research participant, please contact Dr. Emmanuel Clottey at 318-797-5114 or [email protected].

This project has been approved by the Institutional Review Board of LSU Shreveport.

Agreement Statements:

Do you have any questions about the project? (Circle one)

Yes No

Do you agree to take part in the project? (Circle one)


Yes No

Appendix B

Practicum Interview Questions

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?


Documents

Final Paper Grandparents Raising Grandchildren in Shreveport