Extended Family Care Research Articles

The Self-Rated Health of Grandmothers Caring for Grandchildren: Evidence from South Africa

Globally older people are increasingly providing care for their grandchildren. A pertinent question across world regions is the extent to which providing care for grandchildren intersects with the ageing process and the implications for grandparents’ wellbeing. This paper examines the relationship between caring for grandchildren and the self-rated health of older African women (n = 1,397) in South Africa, drawing on data from the National Income Dynamics Study. This is a population which faces significant socio-economic challenges and stresses from the legacy of the HIV epidemic but benefit from a supportive social protection system and strong norms of extended family care. The findings show that prior self-rated health is not associated with assuming primary caregiving responsibilities for grandchildren, suggesting there is no selection effect into caring responsibilities. However, after controlling for prior characteristics, older women who take on primary caring responsibilities for grandchildren have significantly lower odds of reporting poorer self-rated health. Thus, in contrast to the frequent conclusions of negative impacts of custodial grandparenting on grandparent health in the US, this paper indicates that in some cultural contexts grandparents taking on the primary responsibility for grandchildren can be protective for health. Policymakers need to recognise the important caregiving role of grandparents and support them to flourish.

Coaching Parents About Children's Needs and Navigating the Child Protection and Other Systems

This article reviews developments in the NSW child protection system which aim to reduce the number of children in state care. The first development was changes to the Children and Young Persons (Care and Protection) Act 1988 made in 2016 that created a permanency hierarchy for children who have been removed and not restored to parental or extended family care. Under Section 10A of the Act, guardianship and adoption becomes the priority if restoration is not possible, although Aboriginal children are exempt from adoption to some extent. The more recent development, during 2017, is the purchase by the Department of Family and Community Services (FaCS) of a license for two US models, namely Multi-Systemic Therapy for Child Abuse and Neglect (MST-CAN®) and Functional Family Therapy through Child Welfare (FFT-CW®). US studies have shown that these models reduce the number of children being taken into care. Related to this effort is the recognition by FaCS that the cost of out-of-home care (OOHC) is increasingly unmanageable given the 16,843 children in care in NSW. Added to this is the knowledge, confirmed by the Minister, that for many children in OOHC the outcomes are dismal. Finally, the article turns to the issue of poverty and seeks to address the established correlation (not causality) between poverty and child abuse and neglect. This remains the key issue that underscores child abuse and neglect that has to be addressed if a significant reduction in the number of children taken into state care is to be achieved.

CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES.

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.

Extended Family Care: The Neglected Alternative Social Security Practice In Nigeria

Extended Family Care: The Neglected Alternative Social Security Practice In Nigeria

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

BackgroundEnd of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.MethodsRelevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.ResultsOf the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.ConclusionsThe data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.

The Effect of Racial Socialization on Urban African American Use of Child Mental Health Services

SUMMARY Objective: To examine how parental endorsement of racial socialization parenting practices relates to child mental health service use among an urban sample of African American families. Methods: A cross-sectional sample of urban African American parents (n = 96) provided ratings of their beliefs concerning various dimensions of racial socialization constructs, i.e., spiritual or religious coping (SRC), extended family caring (EFC), cultural pride reinforcement (CPR), and assessed regarding their use of child mental health services. Results: At the multivariate level, the use of child mental health services was significantly positively associated with moderate levels of endorsement of SRC and EFC. Inversely, scores in the moderate range of CPR were associated with a reduced likelihood of child mental health service use. Conclusion: Parental endorsement of racial socialization parenting practices appear to play a salient role in child mental health service use among an urban African American families. Further research with larger and more representative samples should be pursued.

Understanding African American Youth HIV Knowledge

Summary This article presents the results of a study examining correlates of urban African American youth HIV knowledge. The influence of family level factors (e.g., family communication, parental AIDS knowledge and myths regarding HIV transmission, along with family composition and family income) are examined. In addition, the current study explores the influence of racial socialization processes, specifically the influence of religious/spiritual coping, extended family caring, cultural pride reinforcement and racial awareness teaching (Stevenson, 1994; 1995; 1997) on youth HIV knowledge. Multivariate analyses revealed a significant association between youth HIV knowledge and being reared in a single parent home. Further, in every model, controlling for all types of racial socialization processes, family communication was significantly associated with youth HIV knowledge. Implications are drawn regarding the development of culturally and contextually specific HIV prevention programming for African American youth and their families.

Extended family caring for children orphaned by AIDS: balancing essential work and caregiving in a high HIV prevalence nations

While over 90 per cent of the 15 million children who have been orphaned by HIV/AIDS are cared for by family members, there is little information about whether adults can meet orphans’ essential caregiving needs while working to economically survive. Using a survey we conducted in Botswana of 1033 working adults, we analyse the experience of adults who are caring for orphans. Over one-third of working adults were caring for orphans and many with few financial resources: 82% were living on household incomes below US$10 purchasing power parity adjusted per person per day. Because of their caregiving responsibilities, they were less able to supplement income with overtime, weekend, evening, or night work. At the same time caregiving responsibilities meant orphan caregivers spent fewer hours caring for their own children and other family members. Nearly half of orphan caregivers had difficulties meeting their children's needs, and nearly 75% weren't able to meet with children's teachers. Pay loss at work compounded the problems: One-quarter of orphan caregivers reported having to take unpaid leave to meet sick childcare needs and nearly half reported being absent from work for children's routine health care. This paper makes clear that if families are to provide adequate care for orphans while economically surviving there needs to be increases in social supports and improvements in working conditions.

Alzheimer Disease International's 10/66 Dementia Research Group - one model for action research in developing countries.

The 10/66 Dementia Research Group (10/66) founded in 1998, is a network of over 100 researchers from mainly developing countries. 10/66 is committed to encourage more good quality research in those regions, where an estimated two-thirds of all those with dementia live. It represents a collaboration of academics, clinicians, and an international non-governmental organization, Alzheimer's Disease International (ADI). 10/66 pilot studies in 26 centres in Latin America, India, Africa and China and SE Asia suggest that education and culture-fair diagnosis is an attainable aim. Despite extended family care networks, these studies also identified high levels of practical, psychological and economic strain upon caregivers. Population-based studies in six centres will now estimate prevalence, describe impact and seek to identify genetic and environmental risk factors in novel settings. At a practical level, 10/66 has studied ways to circumvent the lack of help-seeking in developing countries, and has developed a low-level intervention to educate and train caregivers. The links with ADI and its international networks, and the volunteerism of ADIs members have fostered the rapid growth of 10/66. The partnership facilitates both the raising of awareness and influence upon policy, as 10/66 research evidence can be used by ADI and national Alzheimer's Associations to direct and support advocacy.

Managing Anger

SUMMARY African-American male risk and resilience is viewed as two sides of the same coin in this study that investigates the stability of cluster profiles of racial socialization beliefs. Responses of 208 urban African-American adolescent males from three different samples were used to empirically derive factors of spiritual/ religious coping, extended family caring, cultural pride reinforcement, and racial awareness, which were then submitted to exploratory and confirmatory cluster analyses. Three reliable clusters were found across the samples and were identified as protective, proactive, and adaptive racial socialization beliefs. One-way ANOVAs were conducted on each sample separately and then combined with various psychosocial variables including anger expression, depression, religiosity, calamity fears, and kinship social support. The results supported the hypothesis that young males who hold an adaptive or proactive racial socialization identity tend to demonstrate more prosocial adjustment outcomes. The implications for prevention and community services are suggested.

Kinship Social Support and Adolescent Racial Socialization Beliefs: Extending the Self to Family

This study explored the relationship between adolescent reports of the level of kinship support they experience as members of an extended family network and racial socialization beliefs. A large grupofAfricanAmericanadolescents(n = 229) was administered the Scale ofRacial SocializationforAdolescents (SORS-A), the Kinship Social Support Scale (KSS), and a question regarding the amount of parental communication about racism. MANOVA results indicate significant differences between adolescents with high, moderate, and low levels of kinship support across three offour SORS-A factors (i.e., spiritual and religious coping, extended family caring, and cultural pride reinforcement). These factors make up the proactive dimension of adolescent racial socialization beliefs. The protective dimension (i.e., racism awareness teaching) was nonsignificant in relationship to kinship support. Future research on the importance of the relationship of ecological networks and racial socialization attitudes is discussed.

Outcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement

This study is a randomized clinical trial designed to test the psychosocial efficacy of a pre- and postpartum home visitation model for women at-risk for out-of-home placement of their newborns. Two hundred twenty-five pregnant women with high risk pregnancies for psychosocial reasons were recruited into the study and randomly assigned to an experimental ( n = 125 ) or control condition ( n = 100 ) when they presented for prenatal care at a large urban clinic. After an average of 16 months of exposure to the intervention, women in the experimental group reported significantly greater access to services and there was a trend for the experimental group to show a decrease in psychological distress. At 10 months, there was a trend for experimental group women to experience an increase in social support, but this was not sustained at 16 months. Although the difference was not statistically significant, a higher percentage of women in the experimental group had children in out-of-home living arrangements. There was also a trend among those with children in placement, for children of experimental group women to be placed in extended family care rather than foster care more frequently than controls. The implications of the findings for interventions with at-risk families are discussed.

Senile dementia in Japan: Prevalence and response

Early studies of the prevalence of dementia in Japan indicated low rates, but more recently rates have been rising to the levels shown in other countries. Extended family care of the elderly has been typical, but recent developments suggest that this is declining. The implications of recent social changes for the care of the demented elderly are discussed.

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe.

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Validation of the Scale of Racial Socialization for African American Adolescents: Steps toward Multidimensionality

Little empirical work has been initiated that broadens the definition of racial socialization and its measurement to integrate it with current theoretical discussion of racial identity developmentand AfricanAmerican cultural characteristics and strengths. This study reports the development and validation of the Scale of Racial SocializationforAdolescents (SORS-A). A principal components analysis was conducted following administration of the SORS-A and measures of demographics, family communication about racism, and perception of skin color to 200 African American urban teenagers. Four factors were found to be very meaningful and moderately reliable. The racial socialization factors include Spiritual and Religious Coping, Extended Family Caring, Cultural Pride Reinforcement, and Racism Awareness Teaching. A second-order factor analysis to identify underlying themes was also conducted. Themes of protective and proactive racial socialization were found to be supportive of a theoreticalframework for racial socialization that is multidimensional and inclusive of both socially oppressive and culturally empowering experiences.

Foster Care vs. Extended Family Care for Children of Incarcerated Mothers

This research compares the quality of the substitute care being provided to children in the care of relatives by reason of their mothers' incarceration, with care provided by foster parents. The quality of care from the foster families, assessed with the HOME Inventory was rated significantly better than from relatives for the 3-6 year old children, but equal for the infants and toddlers. The comparatively higher SES Foster care providers also reported more available support from informal social networks and more appropriate expectations and non-abusive discipline toward the children in their care.

Children in Third World slums.

As an example of the miserable conditions for children in third world slums the Dharavi area northwest of Bombay is described. India has the 3rd largest urban population in the world after the U.S. and the U.S.S.R. and is expected to be 45% urban by 2000. Dharavi covers 4.5 square km possibly the largest slum in Asia with 800000 people. Most of the dwellings are single-story huts home 3-8 people about 3 m square with no sanitation paved roads or windows. About 1/4 of the mothers were born there but 1/3 arrived in the past 5 years. Most children are without benefit of traditional extended family care and live in culturally heterogeneous neighborhoods. 99% were breast-fed however the majority received sweetened water for the 1st 3 days and 11% were exclusively breast-fed at 11 months of age. The 25% who were supplemented at 8 months received inadequate amounts of contaminated food. Severe malnutrition was observed in 1% of boys and 5% of girls less than 6 months of age. After 6 months girls were 10 times as likely to be malnourished as boys but no difference was found in malnutrition between all breast-fed or supplemented children. The prospect for slum dwellers here is bleak. Possibly application of practical technology immunizations and education to stimulate community participation and self-reliance in health will be advantageous.