Susan J. Kelley

Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development

Abstract Objective: To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. Method: We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children’s mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. Data analysis: Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children’s mental, motor and language development over time. Results: Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children’s mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. Conclusion: Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.

Grandmothers Raising Grandchildren: Results of an Intervention to Improve Health Outcomes

PURPOSE To examine the impact of an intervention to improve the health of grandmothers raising grandchildren in parent-absent homes. DESIGN A longitudinal, pretest-posttest design. METHODS The sample was composed of 529 female caregivers with a mean age of 56.7 years (range 38-83) who were predominantly low-income African Americans. Data were collected prior to the intervention and again at 12 months when the intervention was complete. The intervention involved home visitation by registered nurses and social workers, as well as other support services. The Short Form-36 was used to assess physical and mental health, using eight multi-item scales. RESULTS A comparison of pre- and posttest mean scores on the SF-36 indicated significantly (p < .003) improved mean scores for vitality, physical effects on role functioning, emotional effects on role functioning, and mental health. No significant differences were found for other attributes. CONCLUSIONS These preliminary findings suggest that grandmothers raising grandchildren may benefit from a home-based intervention designed to improve health attributes. Implications for nursing practice, policy, and research are presented. CLINICAL RELEVANCE The health of grandmother caregivers is critical to their ability to parent grandchildren successfully. Nurses practicing in a variety of settings are in a unique position to identify and address the health challenges of grandmothers who are raising grandchildren.

Results of an Interdisciplinary Intervention to Improve the Psychosocial Well-Being and Physical Functioning of African American Grandmothers Raising Grandchildren

ABSTRACT This paper describes the effects of an interdisciplinary intervention designed to enhance family adaptation toward stress of grandmothers raising grandchildren by improving their psychosocial well-being and physical functioning. Participants were predominantly low-income, African American grandmothers raising one or more grandchildren in parent-absent households in an urban area in the southeast. The intervention consisted of social work and nursing case management, participation in monthly support groups, and parenting classes, as well as legal service referrals for those seeking custody or adoption of their grandchildren. Results indicated that there were statistically significant differences in the direction predicted for psychological distress, family resources, social support, and family coping, but not physical health. These findings suggest that the intervention positively affected the psychosocial well-being of grandmothers raising grandchildren. Implications for practice, policy, and research are discussed. doi:10.1300/J194v05n03_04

To Grandmother's House We Go... and Stay: CHILDREN RAISED IN INTERGENERATIONAL FAMILIES

An increased incidence in child abuse and neglect has resulted in a dramatic rise in the number of grandparents raising grandchildren and great-grandchildren. Grandchildren raised by grandparents often suffer from emotional and behavioral problems due to prior abuse, neglect, and abandonment. Grandparent caregivers experience increased health problems, psychological distress, and social isolation related to their roles as primary caregivers of children. Grandparents who become caregivers of grandchildren face increased financial responsibilities at a time in their lives, close to or at retirement, when income is dramatically decreased.

Psychological distress in African American grandmothers raising grandchildren: the contribution of child behavior problems, physical health, and family resources.

Diminished psychological health has been identified among caregiving grandmothers. The intent of this investigation was to examine psychological distress levels, as well as their predictors, in a sample of 480 caregiving African American grandmothers, mean age 56 years. Almost 40% (39.8%) of participants had clinically elevated psychological distress scores. Results of hierarchical multiple regression indicated that internalizing and externalizing child behavior problems, poor grandmother physical health, younger age of grandmother, and lack of family resources predicted 31% of the variance in psychological distress. Results provide direction for nursing interventions aimed at enhancing the psychological well-being of caregiving grandmothers.

African American Caregiving Grandmothers: Results of an Intervention to Improve Health Indicators and Health Promotion Behaviors

The purpose of this study was to examine the efficacy of an intervention to improve the health of grandmothers raising grandchildren. A pre- and post-test design was employed with 504 African American grandmother participants. The intervention included monthly home-based visitation by registered nurses (RNs) and social workers, participation in support groups and parenting classes, referrals for legal services, and early intervention services for children with special needs. The Health Risk Appraisal was used to assess health indicators and health promotion behaviors. A comparison of pre- and post-test scores indicated significant (p < .002) changes in the desired direction for a number of health indicators and health promotion behaviors, including blood pressure, annual routine cancer screenings, frequency of weekly exercise, and improved dietary intake, as well as participants’ perception of their health and life satisfaction. No improvements were observed in the proportion of participants who were obese or overweight.

Grandmothers Raising Grandchildren with Disabilities: Sources of Support and Family Quality of Life.

Sources of support and quality of life of 50 grandmother-headed families raising grandchildren with and without disabilities were examined. Comparative analyses revealed significant differences between grandmothers raising grandchildren with and without disabilities in regard to sources of support and family quality of life. Informal support was significantly higher for grandmothers raising grandchildren without disabilities. In addition, grandmothers raising grandchildren without disabilities rated satisfaction with all aspects of family quality of life except parenting as significantly higher than grandmothers raising grandchildren with disabilities. Correlational analyses showed a moderate correlation between sources of support and family quality of life for both groups of grandmothers. While total informal social support was significantly correlated with satisfaction ratings of family quality of life for both groups of grandmothers, total formal support was significantly correlated with satisfaction ratings of family quality of life only for grandmothers raising grandchildren with disabilities. Multiple regression analyses revealed a significant relationship between presence of child disability and satisfaction ratings of family quality of life.

Depression, Social Support, and Mental Health A Longitudinal Mediation Analysis in African American Custodial Grandmothers

Custodial grandparents raising grandchildren experience intense levels of stress that can lead to depression and other forms of psychological distress. Drawing on a coping model of family stress, adjustment, and adaptation, we explored the relationship between depression and mental health quality of life mediated by social support and moderated by grandparents age. The sample consisted of 667 African American custodial grandmothers, dichotomized into two age groupings, ≤55 (n = 306) and 55 + (n = 361). All grandmothers participated in a 12-month support intervention. The prospective analysis revealed social support was a mediator in the association between depressive symptoms and mental health quality of life for older African American grandmothers; however, this same relationship did not hold for their younger counterparts. Study limitations and future research directions are discussed.

The Role of Nonphysician Health Care Providers in the Physical Assessment and Diagnosis of Suspected Child Maltreatment: Results of a National Survey

The physical diagnosis and treatment of child abuse and neglect have traditionally fallen in the domain of physicians; however, nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) are assuming increasing roles in the evaluation and treatment of maltreated children. The role of nonphysician health care providers in evaluating cases of suspected child maltreatment (CM) is not without controversy and deserves close attention for several reasons. First and foremost, a diagnosis of suspected CM has serious civil and criminal legal ramifications. A “false positive” evaluation—concluding that abuse occurred when it has not occurred—could result in the wrongful removal of a child from his or her family, or criminal prosecution and conviction of an innocent individual, or both. On the other hand, a “false negative” finding—failing to diagnose suspected abuse when in fact it has occurred—could result in subjecting a child to subsequent abuse, resulting in increased physical and psychological harm. Because cases of CM often rely heavily on physical findings and laboratory evidence, examiners must be adequately prepared to perform such examinations. Expert testimony also plays a critical role in child abuse litigation. According to federal law, before a professional may testify as an expert witness, the judge must be convinced that the professional possesses sufficient “knowledge, skill, experience, training, or education” to qualify as an expert. Do RNs, NPs, and PAs possess the credentials necessary to qualify as expert witnesses in cases of CM? The purpose of this article is to describe the roles, responsibilities, and qualifications of NPs, RNs, and PAs working in the field of CM. More specifically, the results of a national survey of NPs, RNs, and PAs who perform physical assessments in cases of suspected child physical abuse, neglect, and sexual abuse will be presented.

Case Law Regarding Nurses as Expert Witnesses in Child Abuse

Nurses who work with abused children are often subpoenaed to testify in court. This article is designed to empower nurses with reviews of case law that demonstrates how nurses are successful and important participants in the prosecution of child abuse. One barrier to nurses’ expert testimony is the belief that physical examination, diagnosis of the cause of injuries, and documenting “medical findings” have traditionally been considered the exclusive practice of medicine. However, the courts have consistently upheld nurses’ testimony in over 15 Appellate decisions (International Association of Forensic Nurses, 2001), and contrary to the common assumption that only physicians can diagnose abuse, nurses are qualifying to provide expert testimony regarding the cause of injuries and to other “findings” traditionally labeled medical. The establishment of Sexual Assault Nurse Examiner Standards of Practice (International Association of Forensic Nurses, 1996), enhancements in forensic interviewing techniques, colposcopes, photographic technology, and DNA tracking have all influenced the increasing ability of nurses with specialized education, training, and experience to provide scientific credibility in criminal prosecution of crimes against children and adults. Children who present with allegations of physical, sexual, or combined abuse should ideally be diagnosed and treated by specialized interdisciplinary teams (Giardino, Leventhal, Montoya, & Richardson, 1999; Jaudes & Martone, 1992; Kivlahan, Kruse, & Furnell, 1992). Reality