Caregiving grandmothers and their grandchildren: Well-being nine years later

Children and Youth Services Review 34 (2012) 648–654

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Caregiving grandmothers and their grandchildren: Well-being nine years later Catherine Chase Goodman ⁎ Professor of Social Work, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840, United States

a r t i c l e

i n f o

Article history: Received 24 August 2011 Received in revised form 8 December 2011 Accepted 8 December 2011 Available online 16 December 2011 Keywords: Grandmother caregivers Well-being Grandchild Problem behaviors Longitudinal

a b s t r a c t This longitudinal study addressed change in grandmothers' and grandchildren's well-being over a nine year period. Fifty grandmothers previously studied in 1998–1999 when raising school-aged grandchildren were interviewed again in 2008. For the grandmothers, relationships at time-one with their grandchildren and their adult sons or daughters—the grandchildren's parents—impacted gains in life satisfaction later, but not mental health. Change in the grandchildren's behavior, as rated by the grandmothers, was predicted by their grandmothers' mental health nine years earlier. Furthermore, development of greater closeness in the grandmother–grandchild relationship was associated with improvement in the grandmother's mental health and grandchild's behavior over the nine years. These results demonstrate that quality of relationships during school years is important for the grandmother's evaluation of her life well into the future; the quality of the grandmother–grandchild relationship is central for the well-being of both; and fostering the grandmothers' mental health early-on could contribute to her grandchild's well-being as a young adult. © 2012 Elsevier Ltd. All rights reserved.

1. Introduction Grandparents raising grandchildren have garnered public attention of the past several decades as family guardians, stepping in to provide for vulnerable children in times of need. This growing phenomenon has been fueled by the cocaine epidemic of the 1980s and 1990s and ongoing substance abuse, as well as economic need and other types of parental incapacity, such as mental illness, incarceration, physical illness, HIV/AIDS, and death. Census reports have estimated that the number of grandchildren being raised by grandparents without a parent in the household was 1.6 million in 2004 (Kreider, 2008). A new census question introduced in 2000 asked co-resident grandparents if they were caregivers; that is, were they responsible for most of the basic needs of their grandchildren. At that time, 2.4 million grandparents said they were caregivers (Simmons & Dye, 2003), which has remained about the same at 2.45 million by 2006 (U.S. Census Bureau, 2006). Many of these families—about one third—had no parent living in the household. Although grandparents participate in the lives of their grandchildren in many ways, families with grandparents solely responsible for their grandchildren are a unique category, often referred to as skipped generation families.

1.1. Grandparent well-being and relationship factors There has been considerable attention to the well-being of grandparent caregivers, who have typically stepped in during family crisis ⁎ Tel.: + 1 562 985 8688. E-mail address: [email protected]. 0190-7409/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2011.12.009

to parent children in need. Research has identified risks as depression (Letiecq, Bailey, & Kurtz, 2008; Minkler, Fuller-Thomson, Miller, & Driver, 1997) and poor health (Grinstead, Leder, Jensen, & Bond, 2003; Musil & Ahmad, 2002), as well as stress (Ross & Aday, 2006). Minkler et al. used a longitudinal design: Adjusting for precaregiving depression, they identified depression as characteristic of grandparents who began caregiving during the previous five years compared to non-caregiving peers in the Survey of Families and Households (Minkler et al., 1997). Health outcomes have also been studied by Minkler and Fuller-Thomson (1999) using the National Survey of Families and Households. Skipped generation grandparents, without a parent at home, were 50% more likely to have activity of daily living limitations compared to non-caregiving peers. Poor health contributed to greater mental health risk in grandparent caregivers and has been related to greater negative and lower positive affect (Pruchno & McKenney, 2002), stress (Musil & Ahmad, 2002), and distress (Kelley, Whitley, Sipe, & Yorker, 2000). Ethnicity is generally related to health status, with higher mortality for African Americans compared to Whites, although this result is confounded by income inequities (Williams, 2005). Most studies of grandparent well-being have been cross sectional, but a handful of longitudinal studies have considered the grandparents' well-being over time or factors related to improvement or decline. Tracking well-being among caregivers over 10-months, Musil (2000) found parenting distress increased, although depression and anxiety stayed the same for their sample of 74 primary and partial caregivers. Another study follow-up (Hayslip, Emick, Henderson, & Elias, 2002) found stability over a short term (6-months) in a sample of 54 traditional and custodial grandparents. A longitudinal pilot study (Goodman & Hayslip, 2008) of 181 caregiving grandmothers found

C.C. Goodman / Children and Youth Services Review 34 (2012) 648–654

that over approximately 16 months, physical health declined but mental health remained stable. Time that the grandchild lived with the grandmother predicted improvement in mental health, suggesting grandmothers made adjustments over time. Time spans studied have typically been short, although a recent study in Kenya of grandparents, some caring for orphans of parental HIV/AIDS, used three waves of data collected from 2005 to 2007 (Ice, Yogo, Heh, & Juma, 2010). Ice et al. found that mental health declined over time for caregivers but not non-caregivers. Overall, evidence suggests mental health risks for grandparent caregivers, with some declines over time. Building on this literature, this study focuses on factors related to gains or declines in the well-being of grandmother and grandchild over an extended time period. One possible factor contributing to risk is the grandparent's relationship to their adult child—the parent. Assuming care for grandchildren is often a crisis focused on the parents' incapacity, ranging from death to financial instability. Many skipped generation families experience serious parental difficulties, such as substance abuse or legal events, as well as mental illness, resulting in child neglect or abuse (Goodman & Silverstein, 2002; Musil & Ahmad, 2002; Pruchno, 1999). Relationships between grandparent and parent are shaped and often disrupted by these difficult circumstances. Among grandparent caregivers, lack of a close relationship or conflict with the parent has been found to be related to lower well-being across ethnicities (Goodman & Silverstein, 2002), reduced caregiver satisfaction for White but not African American grandmothers (Pruchno & McKenney, 2002), and greater caregiver stress (Sands & GoldbergGlen, 2000). Therefore, the relationship with the parent as well as the circumstances leading to grandparent care may contribute to grandparent well-being over time. In spite of relationship disruption, the grandmother and adult child may have some degree of closeness, benefits of a mutual family history, and shared residual attachment from earlier childrearing days. Based on attachment theory, the grandmother's relationship with her adult child and grandchild reflect caregiving as a behavioral system, which provides a foundation for attachment (Collins, Ford, & Feeney, 2011; Poehlmann, 2003). Initially founders of attachment theory identified attachment styles (secure versus anxious or avoidant) in studies of children, and these have been broadly applied to adulthood, intimate relationships, and even leader–follower relationships (Collins et al., 2011). The founders conceived of attachment theory as relevant across the entire life span, “from cradle to grave” (Bowlby, 1979, p. 129; Shaver & Mikulincer, 2010). Typically, the attachment networks of older adults diminish in size and adult children become increasingly important attachment figures (Cicirelli, 2010). However, for many caregiving grandparents, adult children are not viable attachment figures. As grandparents age, they may look to young adult grandchildren if they are ill or in need of help (Goodman, Scorzo, Ernandes, & Alvarez-Nunez, in press). The relationship to the grandchild is central, a critical remaining family attachment, and the grandmother has made a commitment to the grandchild and to a second round of parenting. In light of the sometimes tumultuous circumstances leading to the arrangement, grandchildren may experience loss of parents, erratic or neglectful parenting, disruptions in friendship or school routines, and ongoing uncertainty as they come to live with their grandparents. They may arrive in grandparent care distressed, acting out, depressed, or anxious (Sands & Goldberg-Glen, 2000). These difficulties make relationships tense and have been found to correlate to lower grandmother well-being. Researchers have linked grandchildren's behavior problems to the grandmother caregivers' stress (Sands & Goldberg-Glen, 2000), lower mental health (Hayslip, King, & Jooste, 2008), distress, lower role satisfaction and meaning (Hayslip, Shore, Henderson, & Lambert, 1998), and depression (Young & Dawson, 2003). Sometimes problems arise from the crisis of separation from parents, from abuse predating grandparent care; other times problems stem from

649

difficulty adjusting to grandparent care, or from deficiencies in the parenting provided by the grandparent. In any case, behavior problems have been related to deteriorated grandparent–grandchild relationships (Hayslip et al., 1998). In contrast, when the relationships with grandchildren are close, caregivers experience greater role satisfaction (Hayslip, Temple, Shore, & Henderson, 2006), and better physical health (Goodman, Tan, Ernandes, & Silverstein, 2008). The relationship between grandmother and grandchild is a core source of attachment for both grandmother caregiver and grandchild, sometimes shaped during crises and developed through caregiving commitment. The closeness in the relationship between grandmother and grandchild suggests high relationship quality and the centrality of this relationship even as the grandchildren gain autonomy and grow into adolescence and young adulthood. Although attachment styles are not the focus of this study, attachment style has been related to quality of relationship and positive descriptions of related others (Shaver & Mikulincer, 2010). This study addresses closeness in the grandmother–grandchild relationship over time and the grandchild's behavior problems as an early factor that may impact the grandmother's well-being nine years later. 1.2. Grandchild well-Being Recent studies have addressed the outcome of children raised by grandparents in an attempt to evaluate the benefits of grandparent care. Studies may focus on children raised in skipped generation families (Goodman & Silverstein, 2002; Smith & Palmieri, 2007) or those raised by grandparents or other kin, referred to as kin care (Carpenter & Clyman, 2004; Sun, 2003). Examination of child well-being is ultimately connected to the grandmother's well-being, and research often depends on the grandmother's perspective to assess grandchild behavior. Overall, just as grandparent caregivers are at risk for lower well-being, grandchildren are at risk for having behavior problems, often demonstrating more severe problems compared to normative or other populations. To be sure, some lower performance in the academic area has been identified for children raised by grandparents among low income families (Pittman & Boswell, 2007), adolescents raised in nonbiological families (Sun, 2003), and children raised by skipped generation grandparents (Solomon & Marx, 1995). Sun (2003) also found adolescents raised in non-biological-parent families to have lower self-esteem and more behavioral problems compared to those raised in parent families. But Solomon and Marx (1995), using a national sample, found no difference between children raised by custodial grandparents and those raised in two parent families on health or obedient behavior at school. Academic achievement deficits were the consistent theme for children raised by grandparent or other kin among this group of studies. Behavior problems, typically an index of children's distress, was another theme in children raised by grandparents in skipped generation families. Goodman and Silverstein (2002) found that children in skipped generation families were more likely to display behavior problems compared to those in three-generation families. More recently, Smith and Palmieri (2007) used National Health Interview Survey (n = 9878) data to compare children raised primarily by parents to 733 children raised by skipped generation grandmothers recruited both by population sampling and by convenience. Skipped generation grandchildren had more behavioral problems compared to children in the normative sample regardless of how they were sampled. All dimensions showed differences: emotional symptoms, conduct problems, hyperactivity and inattention, peer problems, and prosocial behavior. Additionally, the grandmother's stability and well-being has been shown to be a factor in predicting the grandchild's problem behaviors. Smith, Palmieri, Hancock, and Richardson (2008), found the grandmother's distress was mediated by dysfunctional parenting in

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C.C. Goodman / Children and Youth Services Review 34 (2012) 648–654

predicting the grandchild's adjustment, such that less grandmother caregiver distress and better parenting predicted fewer child behavior problems. A related result was found in independent pilot studies. The grandmothers' mental health or parenting stress impacted the behavior of their grandchildren at a later time (Goodman & Hayslip, 2008). Hayslip identified parental stress as a marginal predictor of grandchild problem behaviors over time based on reports of 36 custodial grandparents. Goodman studied 181 grandmother caregivers over a one to two year period and found that the grandmothers' higher mental health ratings at time-one predicted improvement in her grandchildren's behavior. High quality caregiving relationships, including those between grandparents and grandchildren, would likely provide a secure base for grandchildren to explore and a safe haven in times of distress according to attachment theory (Collins et al., 2011). Grandmothers who have been able to provide a high level of sensitivity in parenting their grandchildren may help grandchildren control and overcome behavioral and academic problems. Therefore, the special sensitivity of the caregiving grandmother, her consistency, emotional stability, and mental health are particularly important to her grandchild's capacity for development of secure relationships (Collins et al., 2011; Poehlmann, 2003). 1.3. Problem statement This study looks at predictors of the grandmother's well-being; and of her grandchild's well-being as rated by the grandmother. Using an attachment theory perspective, it is expected that relationship closeness corresponds to quality of relationship in the attachment network (Cicirelli, 2010). In terms of the grandmother's well-being, the quality of relationship between grandmother and parent—often a lost relationship— and the parents' substance or emotional problems leading to grandparent care are expected to predict her well-being at a later time. Similarly, the quality of the relationship between grandmother and grandchild and the level of the child's behavioral problems early-on may contribute to the grandmother's well-being years later. In terms of the grandchild's well-being, both the caregiving relationship between grandchild and grandmother and the level of the grandmother caregiver's well-being over time might impact the grandchild's behavior problems as these children become young adults. Attachment perspective and previous research suggests that caregiver stability and strength—well-being—are important in shaping the relationship, as well as the eventual level of problem behaviors shown by the grandchild (Shaver & Mikulincer, 2010). Therefore, the study focuses on the following questions: 1. A. To what extent will early (Time One, T1) grandchild behavior problems and grandmother–grandchild closeness (or change in closeness over time) predict the grandmother's life satisfaction after nine years (Time Two, T2)? B. Similarly, to what extent will early (T1) parental substance/ emotional problems and grandmother–parent closeness (or change in closeness over time) predict the grandmother's life satisfaction after nine years (Time Two, T2)? 2. A. To what extent will early (Time One, T1) grandchild behavior problems and grandmother–grandchild closeness (or change in closeness over time) predict the grandmother's mental health after nine years (Time Two, T2)? B. Similarly, to what extent will early (T1) parental substance/ emotional problems and grandmother–parent closeness (or change in closeness over time) predict the grandmother's mental health after nine years (Time Two, T2)? 3. A. To what extent will T1 caregiver relationship factors (closeness to grandmother or change in closeness) predict T2 grandchild's behavior problems?

B. To what extent will T1 well-being factors in the caregiver (life satisfaction and mental health or change in life satisfaction and mental health) predict T2 grandchild's behavior problems? 2. Methods 2.1. Sample and data collection The sample consists of 50 African American and White grandmother caregivers who participated in a previous study conducted 8–10 years earlier. The previous study, funded by the National Institute on Aging, recruited 1058 co-parenting and skipped generation grandmother caregivers through announcements distributed in 223 of 792 schools in the Los Angeles Unified School District, as well as media announcements. At that time, grandmothers received a $15 payment and a $5 McDonald's gift certificate. Although the original sample included African American, White, and Latina grandmothers, and both co-parenting and skipped generation families, the current small, minimally-funded pilot study is focused on African American and White skipped generation grandmothers. Therefore the current sample was drawn from a pool of 423 African American and White skipped generation grandmothers that were part of a purposive quota sample in the original study: additionally they or their husbands were head of household, and they were raising grandchildren without a parent in the household. A sample of 105 grandmothers (56 African American and 49 White) was randomly drawn from 423 skipped generation grandmothers previously interviewed in 1998–2000, drawing continuously for 105 potential respondents (without postal returns for wrong address). Overall response rate for grandmothers we attempted to contact was 47.6% (32.1% for African American and 65.3% for White grandmothers). Of those grandmothers, 4.7% were deceased, 4.7% overtly declined, 14.3% were nonresponsive or soft refusals, and other non-responders were unreachable (no phone or no information). Therefore, respondents were disproportionately White and residentially stable. A $20 incentive was offered for a telephone interview. Grandmothers rated their own well-being and evaluated the well-being of one target grandchild, who had been selected for the original study (the grandchild from the school of recruitment or the one with the most recent birthday if identified through the media). Telephone interviews (approximately 1 h) were conducted by a team of 3 volunteer professional social workers and one graduate level social work student. 2.2. Sample characteristics Participants were African American (36%) and White (64%) grandmothers, average age 67 (T1 age m = 58.6, sd = 6.5), and only 36% were married (T1 48% married; see Table 1). A few of the grandmothers (7, 14%) became divorced, separated or widowed during the previous nine years and one had married. Per capita family income for 2007 ranged widely, with half the sample describing their per capita family income as $20,000 or less and mean per capita family income of $19, 653 (T1 per capita income was m = $13, 559 and sd = 7898). Over the past 8–10 years, most grandmothers had made gains in per capita family income (74%). Most grandchildren were age 18 or over, with a mean age of 19 years (T1 age was m = 10.0, sd = 3.4). Slightly more grandchildren were female (52%), 60% were White, and grandchildren had lived with their grandmothers an average of 14 cumulative years (T1 years with grandmother were m = 6.9 years, sd = 4.3). Most (31, 62%) still lived with their grandmothers, and others were living independently, with friends, with a parent, with a spouse/partner, or at school. Most attended school (27, 54%) and 13 (26%) were working. Only a few were married or with a partner (3, 6%) and a small

C.C. Goodman / Children and Youth Services Review 34 (2012) 648–654 Table 1 Demographic description of sample at time two (N = 50). Characteristic Grandmothers Age Under 60 60–69 70–79 80 or over Ethnicity African American White Married Change in marital status Became married Became unmarried Per capita family income 2007 $10,000 or less $10,001–20,000 $20,001–30,000 $30,001 and over Change in per capita family income Same or lost income Gained income Grandchildren Age Under 18 18 or over Gender Male Female Ethnicity African American White Cumulative years with grandmother Under 10 10–19 20 or over Currently living with grandmother In school Working Married or with partner Has a child Clinical BRIC at T2 Clinical BRIC at T1

n

%

6 29 12 3

12 58 24 6

18 32 18

36 64 36

1 7

2 14

10 18 12 10

20 36 24 20

13 37

26 74

20 30

40 60

24 26

48 52

20 30

40 60

6 37 7

12 74 14

31 27 14 3 4 24 25

62 54 28 6 8 48 50

m

(sd)

67.26

(6.43)

19,653

(10,655)

18.86

(3.54)

14.37

(4.98)

Note: Clinical BRIC is Behavior Rating Index for Children, using author recommended cut-off indicating more serious clinical problems. χ2 = .321, df = 1, p = .778; 48% had lower problem ratings at T2 compared to T1; 44% had moved into the clinical range at T2.

proportion had become parents (4, 8%). Lastly, the grandmother's ratings of the grandchild's behavior (Stiffman, Orme, Evans, Feldman, & Keeney, 1984) showed 48% had behavior problem within the clinical range. This was statistically the same as the proportion that had clinical ratings at T1 (50%).

2.3. Measures Grandmothers well-being was measured using the Satisfaction with Life Scale (Diener, Emmons, Larson, & Griffin, 1985) and the SF-36 (Ware, 1993). The Satisfaction with Life Scale consists of five items, such as, “So far I have gotten the important things I want in life,” rated from 7 (strongly agree) to 1 (strongly disagree). This scale had a coefficient alpha at T1 of .85; and at T2 of .87. The SF-36 is the short form of a health survey used in the Rand Medical Outcomes Study. The measure consists of eight subscales that are collapsed and normed to form mental and physical health indices used in this study. Coefficient alpha reliabilities for SF-36 subscales at T1 ranged from .65 for Social Functioning to .94 for Role Physical. SF-36 subscales at T2 ranged from .76 for Role Emotional to .93 for Physical Functioning.

651

The grandchild's well-being was measured using the Behavior Rating Index for Children (BRIC), a 13-item problem list rated on a 5-point scale from 1 (rarely or never) to 5 (most or all of the time; Stiffman et al., 1984). The measure consists of 10 problems, with an additional 3 positive items to avoid response bias, which do not contribute to the final score. The problem list addresses emotional, behavioral, and peer problems such as “Get very upset?” “Hide (his/ her) thoughts from others?” and “Get along poorly with others?” Coefficient alpha was .78 at T1 and .80 at T2. This measure correlated .74 with Goodman's Difficulty Questionnaire at T2, which has been used successfully by grandparent caregivers to rate their grandchildren (Goodman, 1997; Palmieri & Smith, 2007). Although designed for younger children, the BRIC's straightforward questions were used at follow-up for consistency with T1 data. The grandmother's relationships with the grandchild and parent were assessed using 5-items of Bengtson's (1991) measure of Affective Solidarity referred to here as the Closeness Scale. Items were rated on a 6-point scale for emotional closeness, communication, understanding, getting along together, and affection. These items are reflective of quality relationships and apply broadly to either of these family attachments. The scale ranges from 6 (extremely/a great deal) to 1 (not at all/none) and each question is phrased clearly to address a specific relationship by including the name of the related person. The measure is used here as an index of relationship quality and does not address attachment styles. Coefficient alpha for closeness between the grandmother and grandchild was .86 at T1 and .90 at T2. Coefficient alpha for closeness between the grandmother and parent was .92 at T1 and .89 at T2. The Parent's Substance/Emotional Factor, measured at T1 only, was developed for the original study. It consisted of five yes–no items, rating the parent for substance abuse, alcohol abuse, child neglect, legal trouble, and mental/emotional problems. Coefficient alpha at T1 was .64, low but acceptable as an index of a broad range of serious parental problems. This measure addresses the severity of the parental crisis contributing to parental incapacity and grandparent caregiving. 3. Results 3.1. Predictors of grandmother's well-being Hierarchical regression was used to examine predictors of the grandmother's T2 well-being. Multicollinearity was not considered a problem as none of the bivariate correlations were greater than .70 (Tabachnick & Fidell, 2007). The adult children of 4 grandmothers were deceased at T1 (3 adult daughters, mothers of the grandchild, and 1 adult son, father of the grandchild) and one additional adult daughter (mother of the grandchild) had died by T2. Mean substitution of sample values was used on parent variables in order to retain these subjects with no notable change in results. Question 1, factors predicting grandmother's life satisfaction, was addressed using three models in order to maximize power in this small sample: Model 1 consisted of controls (T1 physical health, income, and ethnicity), including adjustment for T1 grandmother's life satisfaction and showed the extent of continuity in the dependent variable. Model 2 examined the impact of grandchild–grandmother relationship closeness and the grandchild's behavior problems with controls. Both T1 and T2 closeness ratings were included to identify possible changes in closeness over time. Finally, Model 3 examined the impact of parent–grandmother relationship and parent's substance/emotional factor with controls. Again, both T1 and T2 closeness ratings were included in the model. In terms of the grandmother's well-being, her life satisfaction showed considerable continuity, adjusting T2 life satisfaction for T1 life satisfaction and T1 demographic and health variables (see Table 2). This model accounted for 38% of the variance in current

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C.C. Goodman / Children and Youth Services Review 34 (2012) 648–654

Table 2 Multiple regressions for change in life satisfaction/mental health as predicted by relationship and crisis factors: Standardized regression coefficients (N = 50). Life satisfaction T2 Predictors

T1 Life sat/mental health T1 Grandmother's demographics Ethnicity Per capita family income Health Grandchild factors T1 GC behavior problems T1 Close GM–GC T2 Close GM–GC Parent factors T1 Parent substance/ emotional factors T1 Close GM–P T2 Close GM–P Model R2= Adjusted R2= R2Δ= F= df =

Table 3 Multiple regressions for change in child's behavior problems as predicted by attachment and caregiver factors: Standardized regression coefficients (N = 50).

Mental health T2

Child's behavior problemsT2

Model 1

Model 2

Model 3

Model Model 1 2

Model 3

Beta

Beta

Beta

Beta

Beta

Beta

.471⁎⁎⁎

.334⁎⁎

.430⁎⁎⁎

.331⁎

.228

.319⁎

.131 .226

.101 .208

−.008 .253

−.004 −.109 −.084 −.093

−.096 −.099

.144

.117

.138

.138

.163

.154

.186

.077

.367⁎ .195

.091 .517⁎⁎⁎ .116

.379⁎ .103 .375⁎⁎⁎ .507⁎⁎⁎ .496⁎ .319⁎⁎⁎ .425⁎ .412⁎ .375⁎⁎⁎ .132⁎ .121⁎ 6.737⁎⁎⁎ 6.166⁎⁎⁎ 5.902⁎⁎⁎ 4, 45 7, 42 7, 42

.214

.119 .041 .119 1.517 4, 45

.288 .058 .377⁎⁎ .177 .274⁎⁎ .040 .258⁎⁎ .058 3.636⁎⁎ 1.290 7, 42 7, 42

Note: GC = Grandchild; P = Parent; GM = Grandmother; T1 = Time 1; T2 = Time 2. ⁎⁎⁎ p ≤ .001. ⁎⁎ p ≤ .01. ⁎ p ≤ .05.

life satisfaction (semipartial r 2 = .375, with 95% confidence limit from .127 to .554, p b .001). When the grandchild factors were added in Model 2, T1 closeness between grandmother and grandchild was significant and the model accounted for increase in predictive power of 13% (semipartial Δ r 2 = .132, with 95% confidence limit from .000 to .317, p = .036). When parent factors were added to demographic controls in Model 3, T1 closeness between grandmother and parent was significant and the model increased predictive power by 12% (semipartial Δ r 2 = .121, with 95% confidence limit from .000 to .303, p = .048). These modest results show that relationships early-on impact the grandmother's evaluation of her life nine years later. Question 2, factors predicting grandmother's mental health used the same analysis approach with mental health as the dependent measure. Results for grandmothers' mental health failed to show continuity, with T2 mental health adjusted for T1 mental health and demographic/health factors, accounting for a nonsignificant proportion of the variance in the model (only12% of the variance, semipartial r 2 = .119, with 95% confidence limit from .000 to .282, p = .117). When grandchild factors were added in Model 2, the increase in predictive power was 26% (semipartial Δ r 2 = .258, with 95% confidence limit from .055 to .457, p = .001). This demonstrates that change in grandmother–grandchild closeness (T2 adjusted for T1) is related to the grandmother's mental health, a substantial result. No significant effect of parental factors on grandmothers' mental health was found (Model 3; See Table 2). Question 3, factors predicting grandchild's behavior problems were addressed using three models: Model 1 consisted of controls for T1 behavior problems and T1 demographic factors (gender and age). Model 2 added grandmother–grandchild relationship closeness at T1 and T2; and Model 3 consisted of tests for grandmother's wellbeing (T1 and T2 life satisfaction and T1 and T2 mental health) with T1 behavior problems and demographic factors controlled. In terms of grandchild behavior problems (See Table 3), analysis of change from T1 to T2 (evaluated by adjusting T2 behavior problems

Predictors

T1 Child's behavior problems T1 Grandchild's demographics Gender Age Caregiver relationship T1 Close GM–GC T2 Close GM–GC Caregiver well-being factors T1 GM life satisfaction T2 GM life satisfaction T1 GM mental health T2 GM mental health Model R2 = Adjusted R2 = R 2Δ = F= df =

Model 1

Model 2

Model 3

Beta

Beta

Beta

.366⁎

.207

.225

−.010 −.181

.029 −.309⁎

−.077 −.285⁎

−.154 −.543⁎⁎⁎

.151 .095 .151 2.724 3, 46

.463⁎⁎⁎ .402⁎⁎⁎ .313⁎⁎⁎ 7.599⁎⁎⁎

.058 −.117 −.350⁎ −.312⁎ .436⁎⁎⁎ .342⁎⁎ .285⁎⁎ 4.630⁎⁎⁎

5, 44

7, 42

Note: C = Grandchild; P = Parent; GM = Grandmother; T1 = Time 1; T2 = Time 2. ⁎ p ≤ .05. ⁎⁎⁎ p ≤ .001. ⁎⁎ p ≤ .01.

for T1 behavior problems and T1 demographics) showed continuity in the grandchild's behavior, accounting for 15% of the variance at T2 (semipartial r 2 = .151, with 95% confidence limit from .002 to .341, p = .021). Upon addition of the grandmother–grandchild closeness in Model 2, prediction increased 31% (semipartial Δ r 2 = .313, with 95% confidence limit from .109 to .520, p b .001). The significant predictor was current (T2) grandmother–grandchild closeness, suggesting improvement in this relationship was related to improvement in the grandchild's behavior from T1 to T2 (T2 adjusted for T1 relationship). Finally, Model 3 (adjusting for T1 behavior problems and T1 demographics) resulted in an increase of predictive power of 29% (semipartial Δ r 2 = .285, with 95% confidence limit from .057 to .471, p = .001). Change in the grandchild's behavior problems was significantly related to grandmother's mental health at T1 and also to change in her mental health as shown by T2 values adjusted for T1. In summary, change in the grandchild's behavior over nine years was strongly predicted by change in the grandmother–grandchild relationship; and by the grandmother's mental health early on at Time 1, as well as change in her mental health over the nine years. 4. Discussion 4.1. Grandmother's well-being and relationships Grandmother's well-being has been consistently related to the grandchild's behavior problems in cross sectional studies (Hayslip et al., 1998, 2006; Sands & Goldberg-Glen, 2000; Young & Dawson, 2003). This study, on the other hand, found the grandchild's behavior problems failed to predict grandmother well-being nine years later, neither life satisfaction nor mental health. It was the relationship between grandmother and grandchild that predicted the grandmother's later life satisfaction. Results suggest that closeness in the grandchild–grandmother relationship early-on overshadows struggles with the grandchild's behavior problems during early school years. This study shows that grandmother–grandchild relationship closeness is a good indicator of far reaching and lasting elements in skipped generation families, specifically the grandmother's life satisfaction. Other studies of grandmother–grandchild relationship quality have shown an association with caregiver role satisfaction (Hayslip et al., 2006) and physical health (Goodman et al., 2008).

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Life satisfaction is a cognitive factor, based on evaluation life as “close to ideal” and having “gotten important things I want” (Diener et al., 1985). This assessment captures social and personal expectations and ideals. These grandmothers, now in their late 60s might be reviewing and evaluating their lives, assessing the highs and lows of past phases (Leist, Ferring, & Filipp, 2010). This cognitive process may have been impacted by evaluation of their attachments years earlier when they were in the midst of child rearing. On the other hand, grandmother–grandchild closeness early-on was not related to mental health after nine years, although increased closeness over time was related to improved mental health. Mental health consists of current depression, anxiety, tension, and vitality, as well as recent interference of emotional problems with role achievement and activities (Ware, 1993). Relationship quality nine years earlier was overshadowed by changes in closeness over time, or possibly other recent life events that may have strongly impacted current mental health. The parental circumstances surrounding the grandmother's assumption of care for the grandchild during early childrearing had no impact on life satisfaction or mental health in this nine year followup. Overshadowing these difficult circumstances, the closeness of the relationship with the parent early on—in spite of circumstances —was important for the grandmother's evaluation of life nine years later. Some studies have found that conflicted or less closeness in the grandmother–parent relationship were associated with reduced well-being and greater stress (Goodman & Silverstein, 2002; Pruchno & McKenney, 2002; Sands & Goldberg-Glen, 2000). Attachment theory suggests that as attachment networks get smaller in old age, older adults turn to adult children, a normative process associated with aging (Cicirelli, 2010). However, the troubling parental circumstances earlier in the family may have disrupted the grandmother–parent relationship, setting the stage for the grandmother's negative evaluation of her life later. Grandmother–parent closeness early-on was not related to current mental health, although the small sample limited the power to identify significant effects. 4.2. Grandchild's well-being and mentally healthy grandmother caregivers In terms of the grandchild's well-being, behavior problems were reduced over time for grandchildren whose caregivers enjoyed better mental health early on. Furthermore, improvements in the grandmother's mental health and improvements in the grandmother–grandchild relationship closeness were related to positive shifts in the grandchild's behavior. These results confirm that grandmother's mental health can have a long term impact on the grandchild's behavior, just as a short term impact was previously demonstrated in a related sample (Goodman & Hayslip, 2008). This is also consistent with attachment theory in that caregivers with special sensitivity, stability, and better mental health are better able to help troubled children (Shaver & Mikulincer, 2010). Researchers often interpret the association between the child's behavior problems and the grandmothers' well-being as caused by a disturbed grandchild who has often been deprived or neglected by parents prior to grandparent care. However, grandmothers who maintain their own mental health and create a loving, close relationships with their grandchild over time may better assist struggling or deprived grandchildren to control difficult behaviors and successfully develop social skills. 4.3. The key relationship between grandmother and grandchild The growth in closeness in the grandmother–grandchild relationship is related to improvement in the grandmother's mental health and improvement in her grandchild's behavior. This study provides confirmation of the importance of the associations between the

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grandchild's behavior problems, grandparent well-being, and relationship quality, which have been identified in cross sectional studies (Goodman et al., 2008; Hayslip et al., 2006). Results from the current study suggest that grandmother and grandchild can gain in wellbeing together; for example, mental health gains for the grandmother may co-occur with the grandchild's improved behavior, making causality unclear. Furthermore, changes in the grandmother–grandchild relationship would co-occur with the grandchild's behavior problems or the grandmother's mental health. Causality is not clearly determined in this study because these factors are changing simultaneously and dynamically. It is clear however, that grandmother and grandchild can develop and grow together as their relationship deepens and gains in communication and closeness. This close attachment is important for the grandchild, who may need a particularly loving and stable relationship with the grandmother to help weather difficulties with the parent. And across the life span, this attachment is also particularly important for the grandmother who wants to be successful at parenting a second time around (Poehlmann, 2003; Shaver & Mikulincer, 2010). 4.4. Limitations The only respondent in the study was the grandmother, therefore there is potential for her response bias. For example, her mental health might have influenced her ratings, particularly ratings of her grandchild. Furthermore, due to the small sample, predictions may be sample specific and not readily generalized to other samples. Therefore, results of this small pilot study should be considered suggestive only. The small sample was most viable for prediction of large effects (Tabachnick & Fidell, 2007), indicating that squared partial correlations with p ≤ .01 were of greatest interest and might show the greatest reliability. Using a formula for large effect sizes, Tabachnick and Fidell's discussion indicates adequacy of this sample size, although a larger sample would certainly have allowed greater power to identify moderate or weak effects. In short, some results had quite large beta weights that were not statistically significant: given a larger sample these may have become significant predictors. 4.5. Implications for practice Grandmothers, as other caregivers, need to take care of themselves in order to be optimal caregivers to their grandchildren. Maintenance of their own mental health as grandparents is essential to the well-being of their grandchildren. The most common intervention for grandparent caregivers is participation in support groups, although participation is generally quite low. Nevertheless, support groups appear to be on target in their focus. Smith (2003), in a survey of grandparent participants' view of support groups found that over half of grandparent participants highly ranked support groups as “taking care of my needs” and “dealing with family issues.” Research has also verified effectiveness of formal support for grandparent caregivers. For example a study of 133 grandparents found that enacted formal support safeguarded against difficulties with child health and daily hassles in terms of the grandparent's evaluation of their life satisfaction, as well as directly reducing caregiver stress and contributing to life satisfactions (Gerard, Landry-Meyer, & Roe, 2006). Other evaluations have also shown home visits by nurses and social workers to be helpful for grandparent vitality, role functioning, and mental health (Kelley, Whitley, & Campos, 2010). Support groups, formal support programs and professional interventions may contribute to a caregiver's sense of well-being and all provide a forum for discussing relationship issues with the parent and grandchild. In terms of the grandchild, devising interventions based on the attachment framework is productive because attachment theory deals with parental loss and deprivation, as well as dyadic relationships

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across the lifespan (Poehlmann, 2003). As a result mental health and school professionals can help children deal with parental loss/ relationship disruption and adaptation to grandparent caregiving based on the child's developmental level and needs; and can help the grandparents provide sensitive and consistent care. The school is an especially good intervention point allowing a focus on both grandchild and grandparent (Edwards & Daire, 2006). Maximum gains may result from development and growth in the grandchild– grandmother relationship, which is central to the development of both grandchild and grandmother. Acknowledgments The Grandmother Parenting Project was supported in part by grants from the National Institute on Aging (RO1AG14977), and the Scholarly and Creative Activities Award, California State University, Long Beach. Thanks go to Dolores Scorzo, MGS, Patricia Ernandes, MSW, and Areceli Alvarez-Nunez, MSW for assistance in data collection and throughout the project. References Bengtson, V. L. (1991). The longitudinal study of three-generation families: 1991 Survey: Unpublished survey instrument, Andrus Gerontology Center, University of Southern California. Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock. Carpenter, S. C., & Clyman, R. B. (2004). The long-term emotional and physical wellbeing of women who have lived in kinship care. Children and Youth Services Review, 26, 673–686. Cicirelli, V. G. (2010). Attachment relationships in old age. Journal of Social and Personal Relationships, 27, 191–199. Collins, N. L., Ford, M. B., & Feeney, B. C. (2011). An attachment-theory perspective on social support in close relationships. In L. M. Horowitz, & S. Strack (Eds.), Handbook of interpersonal psychology: Theory, research, assessment, and therapeutic interventions (pp. 209–232). Hoboken, NJ: John Wiley & Sons, Inc. Diener, C., Emmons, R. A., Larson, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75. Edwards, O. W., & Daire, A. P. (2006). School-age children raised by their grandparents: Problems and solutions. Journal of Instructional Psychology, 33, 113–119. Gerard, J. M., Landry-Meyer, L., & Roe, J. G. (2006). Grandparents raising grandchildren: The role of social support in coping with caregiving challenges. International Journal of Aging & Human Development, 62, 359–383. Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. Goodman, C. C., & Hayslip, B. (2008). Mentally healthy grandparents' impact on their grandchild's behavior. In B. Hayslip Jr., & P. Kaminski (Eds.), Parenting the custodial grandchild: Implications for clinical practice (pp. 41–52). New York: Springer. Goodman, C. C., Scorzo, D., Ernandes, P., & Alvarez-Nunez, A. (in press). Social and personal resources of grandmother caregivers after grandchildren are grown: A pilot study. In B. Hayslip Jr., & G. C. Smith (Eds.), Resilient grandparent caregivers: A strengthsbased perspective, London: Routeledge. Goodman, C. C., & Silverstein, M. (2002). Grandparents raising grandchildren: Family structure and well-being in culturally diverse families. The Gerontologist, 42, 676–689. Goodman, C. C., Tan, P., Ernandes, P. P., & Silverstein, M. (2008). The health of grandmothers raising grandchildren: Does the quality of family relationships matter? Families, Systems & Health, 26(4), 417–430. Grinstead, L. N., Leder, S., Jensen, S., & Bond, L. (2003). Review of research on the health of caregiving grandparents. Journal of Advanced Nursing, 44, 318–326. Hayslip, B., Jr., Emick, M. A., Henderson, C. E., & Elias, K. (2002). Temporal variations in the experience of custodial grandparenting: A short-term longitudinal study. Journal of Applied Gerontology, 21, 139–156. Hayslip, B., Jr., King, J. K., & Jooste, J. L. (2008). Grandchildren's difficulties and strengths impact the mental health of their grandparents. In B. Hayslip Jr., & P. L. Kaminski (Eds.), Parenting the custodial grandchild: Implications for clinical practice (pp. 53–73). New York: Springer. Hayslip, B., Jr., Shore, R. J., Henderson, C. E., & Lambert, P. L. (1998). Custodial grandparenting and the impact of grandchildren with problems on role satisfaction and role meaning. Journal of Gerontology: Social Sciences, 53B, S164–S173. Hayslip, B., Jr., Temple, J. R., Shore, R. J., & Henderson, C. E. (2006). Determinants of role satisfaction among traditional and custodial grandparents. In J. B. Hayslip, & J. H. Patrick (Eds.), Custodial grandparenting: Individual, cultural, and ethnic diversity (pp. 21–35). New York: Springer.

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