When parents are unable to raise their children, relatives are often called upon to become primary caregivers. In the U.S. approximately 2.5 million kin caregivers have assumed this role—often unexpectedly, due to parental substance abuse, mental illness, violence, domestic violence, abuse and neglect, incarceration, physical illness, death, divorce, deportation and most recently, military deployment (US Census, 2003). These exposures can profoundly affect all members of the family—the children, the biological parents and the kin caregiver.
Research has shown that children living in the care of their relatives function better than those placed in traditional foster care (Rubin et al, 2008). To counter the impact of disruptive separations, kin caregivers (most frequently grandparents) take on this tremendous responsibility to help their relative children maintain a sense of family identity and to provide continuity. There is growing evidence, however, that kin caregivers make tremendous sacrifices for themselves. Much can be done to support these caregivers in this time-disordered role. A number of factors need to be considered, including how practitioners can best respond to the concrete and emotional needs of kin caregivers and how self-care can be emphasized and practiced.
Caregiving causes grandparents and other relatives to alter their lives in later adult developmental stages as they give up ambitions and goals for their future and shift identity to become parents again. They are a generation older, and at times have less stamina, more health problems and greater risk for depression, anxiety and isolation in this role. Many are struggling with complex losses and traumatic events without the necessary resources to cope.
Although the life transition of kin caregiving is filled with challenges and obstacles, a number of interventions can provide support, psychoeducation and validation for the caregivers. When practitioners increase awareness of the challenges and obstacles kin caregivers face, they can develop effective interventions to sustain the caregivers. A thorough assessment is a critical first step that looks at the prevalence of trauma and loss, the functioning and coping capacity of the family, and adaptive and maladaptive responses. Concrete and psychosocial services to address the family’s needs should be identified and provided to the caregiver along with psychoeducation regarding the benefits of assistance. Practitioners may need to guide the caregiver through the application process for concrete services, since each system—e.g. mental health, special education and medical insurance—has specific and often unrelated admission criteria which can quickly become overwhelming.
Practitioners should give careful consideration to the meaning of psychological referrals within the cultural context of the family. For example, in some cultures receiving psychotherapy can carry a stigma or feel threatening. Part of the practitioner’s role is to clarify misconceptions about treatment, describe how it works and alleviate any concerns. Families may also be unaware that Medicaid usually covers the entire cost of therapy and Medicare covers 50%. Practitioners may need to expand a family’s awareness of the broad range of mental health services currently available, such as specific trauma-focused treatments, AA, psycho-educational approaches, health promotion, school-based interventions, expressive art therapies, mediation services and family focused approaches that consider systems of care.
Rather than focusing on pathology, practitioners should utilize a strength model that highlights a family’s resilience and healthy coping skills. Spirituality is often a sustaining force in kin caregiving families. Caregivers frequently describe how their prayers and beliefs help in overcoming difficulties and challenges. (Musil et al, 2000, Langosch, 2005). To decrease isolation, caregivers can be helped to expand their support networks and join a kin caregiver support group. There are more than 500 grandparent support groups across the US (AARP, 2003). The group experience provides a safe place for caregivers to share their range of feelings with others in a similar situation. Grandparents often are very knowledgeable about resources and programs for their families and the group becomes a forum to exchange this information.
Helping caregivers expand their social networks also can ease the burden of caregiving. Comprehensive and wrap-around services that address the emotional, financial, educational, legal and entitlement needs of kinship families are essential. One such program, the Kinship Care Program at the Jewish Board of Family and Children’s Services, offers support groups for caregivers and their relative children, individual and family counseling, case management, advocacy information, referral and psycho-educational forums.
Often caregivers are so focused on their grandchildren’s needs that they take little time for themselves. It is important to help them consider their own self-care and help them develop stress reduction techniques and skills as a means of re-fueling.
Kin caregivers take up the societal slack of raising and nurturing their relative children when parents are unable to do so. These caregivers give so much and receive so little in terms of needed support and services. Practitioners need to respond comprehensively to these families’ needs, identify and validate their strengths and work toward successful outcomes. Services and strategies should strive to build resilience, and sustain and empower these kin in their caregiver role.
The Kinship Care Program at JBFCS provides comprehensive and free services to relative caregiving families in Brooklyn. These services include weekly support groups for kin caregivers and their relative children, case management, advocacy, information, referral, counseling, parent education, and informational forums. For further information, please contact: Dr. Deborah Langosch, LCSW at 212-632-4760 or dlangosch@jbfcs.org or John Watkins, MA at 718-676-4251 or jwatkins@jbfcs.org.
References
American Association for Retired Persons (AARP). (2003). Grandparent Information Center, www.aarp.org, Washington, DC.
Langosch, D. (2005). Grandparents raising grandchildren due to parental loss: Their bereavement process and capacity for adaptation and empathy, Unpublished doctoral dissertation. NY: New York University.
Musil, C., Schrader, S., & Mutikani, J. (2000). Social support, stress, and special coping tasks of grandmother caregivers. In C. Cox (Ed.), To grandmother’s house we go and stay: Perspectives on custodial grandparents (pp. 56-70). NY: Springer Publishing.
Rubin, D., Downes, K., O’Reilly, A., Mekonnen, R., Luan, X., and Localio, R. (2008). Impact of Kinship Care on Behavioral Well-being for Children in Out-of-Home Care. Archives of Pediatric and Adolescent Medicine. 162 (6), 550-556.
United States Bureau of the Census (2003). Statistical abstract of the United States. Washington, D.C.: U.S. Government Printing Office.
