Gregory Smith - US grants

DESCRIPTION (provided by applicant): The global aim is to examine stress and coping among custodial grandparents, a growing but inadequately studied population of family caregivers. The complex links between caregiving demands, coping behaviors, resources, appraisals and physical and mental health outcomes will be explored with a random, nationally-representative sample of 900 grandparents raising grandchildren (ages 4 to 16) due to substance abuse and other causes of child neglect by parents. Of the 900 grandparents, recruited through multiplicity network sampling with random digit dialing, there will be 700 grandmothers and 200 grandfathers from the same households. Data will be collected by a mixed-mode survey including phone interviews and mailed questionnaires. Aim 1 is to test a two-factor model of grandmothers' psychological well-being adapted from stress and coping research on family caregivers to the elderly using structural equation modeling. Depressive symptoms and psychological well-being are regarded as distinct outcomes, with each having unique antecedents within a general model of stress and coping. Physical health is viewed as both a key resource and outcome. Past studies have involved small convenience samples, and have not examined caregiving outcomes within the multivariate context of carefully specified theoretical models. Aim 2 is to determine if both the structural and measurement aspects of the model are invariant for Black (n=350) and White (n=350) grandmothers. Extant studies have involved either White or Black grandparents, and the rare studies involving both races have yielded equivocal findings. Aim 3 is to compare grandmothers and grandfathers along key caregiving constructs within the model. Custodial grandfathers, who have been largely overlooked in past research, are hypothesized to report lower involvement, greater satisfaction, and less role strain and depression related to custodial grandparenting than do grandmothers. Possible race by gender interactions will also be explored. Aim 4 is to obtain baseline data so that this initial cross-sectional investigation may evolve into a longitudinal study. Aim 5 is to archive the data for eventual use by other researchers; The findings of this study will inform the development of interventions tailored to assist custodial grandparents and their families.

[unreadable] DESCRIPTION (provided by applicant): Project Summary: An interdisciplinary team will develop, test, and refine an innovative web-based intervention that expands CG intervention research in four key ways: 1) The intervention is groundbreaking in alleviating depression in CGs and stroke survivors concurrently by enhancing their respective levels of social support, mastery, and self-esteem; 2) The intervention provides a unique blend of peer and professional support that maximizes older adults' increasing desire to communicate and glean information via the Internet; 3) The prominent Stress Process Model is linked with the literature on family stroke care to derive an empirically justified and conceptually sound intervention; and 4) A novel approach is taken to improve the stroke survivor's psychological well-being by fostering the CG's ability to provide skilled care. The intervention is comprised of a Nurse Monitor who oversees, facilitates, and integrates the following components: Video Education Modules designed to help CGs render care in ways that enhance the perceived support, mastery, and self esteem of the stroke survivor; Web-Based Information that is individually tailored to meet the self-identified needs of CGs; and a Chat Room that provides CGs with real- time peer interactions to obtain care advice and peer support. In line with an R21 award, this exploratory/ developmental project involves three phases: Development; Usability Study; and Randomized Control Pilot Study (RCPS). The Development Phase involves standardizing the intervention and assessing its perceived acceptability with a Focus Group Study of CGs, stroke survivors, and health providers. The Usability Study is a trial run with 7 CGs to identify and remedy potential implementation problems. The RCPS is to be conducted with 32 females (age > 50) caring for husbands who are first-time stroke survivors. Dyads will be randomly assigned to either the intervention (n=16) or to a Minimal Support Condition (n=16). Data will be gathered to estimate intervention parameters (e.g., effect size, attrition, perform preliminary power analyses); to investigate CGs1 online information-seeking and communication processes; and to evaluate the feasibility of procedures for implementing and evaluating the intervention in a subsequent full-scale R01 controlled outcome study. African American and White participants will be sampled to explore potential ethnic/ cultural differences in acceptance, perceived value, and effectiveness of treatment protocol, goals, and outcomes. Relevance: This project is important in view of substantial evidence that (a) informal care to stroke survivors is a major public health concern; (b) both stroke survivors and their spousal CGs are at risk for depression; and (c) poor quality of informal care is linked to depressive symptoms within both members of the caregiving dyad. Prior psychosocial intervention research with informal stroke CGs has been scarce, equivocal in findings, methodologically flawed, and without theoretical foundation. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Although prior studies reveal that custodial grandmothers (CGM) and grandchildren (CGC) face high risk for psychological difficulties, virtually no rigorous studies of psychosocial interventions based on solid conceptual frameworks have been conducted with these vulnerable families. In view of preliminary findings that disrupted parenting mediates the relationship between CGM's psychological distress in the caregiver role and CGC's emotional and behavioral problems, this project involves a randomized clinical trial (RCT) of the comparative feasibility and efficacy of two evidenced-based psychoeducational interventions widely used with other caregiver populations. Grandmothers (N = 504) of CGC (age 5 - 12) will be randomly assigned to one of three conditions: Behavioral Parent Training (BPT; derived from Project KEEP for foster parents; Cognitive Behavioral Therapy (CBT; derived from Coping with Caregiving for caregivers of frail elders); Minimal Support Condition (to control for non-specific treatment factors). The proposed universal interventions include prevention and remediation objectives and involve a group format approach with mental health professionals and grandparent peers serving as co-leaders. The RCT will occur in multiple locations across the US to ensure that findings generalize beyond a single area and that equal numbers of Black (n = 168), Hispanic (n = 168), and White (n = 168) families participate. Prior to the RCT, focus groups will be held separately with CGMs of each race (n = 10 apiece) and experienced practitioners (n = 10) with the aim of assessing the perceived importance and acceptability of recruitment methods, treatment goals, and procedures, including possible differences by race/ethnicity. Multiple-informant and multiple-method assessments during the RCT at pretest, posttest and 6, 12, 18, and 24 month follow-ups will include indicators of CGM psychological distress (anxiety, depression); CGC adjustment (internalizing and externalizing problems); and disrupted parenting (use of ineffective discipline and low nurturance). Based on the conceptual framework of the prominent Family Stress Model, multi-group structural equation modeling analyses will be used to achieve four aims: (a) To compare the short and long-term effectiveness of CBT and BPT; (b) to examine longitudinally the dynamic linkages between CGM parenting practices, CGM' psychological distress, and CGC adjustment as modified by BPT and CBT; (c) to determine if key moderating variables (race/ethnicity, CGC, initial psychological difficulties in CGC and CGM influence RCT outcomes; and (d) to examine key factors related to acceptability and adherence to the proposed interventions. The findings will inform future clinical practice with custodial grandfamilies by identifying which of the proposed interventions are most effective and most acceptable among specific sub-groups (e.g., race/ethnicity; initial risk) and by unraveling the specific antecedent-consequent relations among CGM distress, dysfunctional parenting, and CGC adjustment.

SUMMARY: We examine the efficacy of an online Social Intelligence Intervention (SII) at improving the health and well- being of custodial grandmothers (CGMs) and their adolescent custodial grandchildren (ACG) through mutual enhancement of their social competencies. This target population is of particular importance because both CGMs and ACG experience significant early life adversities that lead to hypervigilance of others, mistrust, social isolation, interpersonal conflict, and the inability to garner warmth and support from family and friends. Numerous studies have shown that these relational challenges within ?risky families? often lead to life-long interpersonal difficulties that increase the probability of behavioral and physical health problems. Furthermore, adolescence is a key period for the development of social competence, which is influenced by supportive caregiving and positive modeling from female parent figures. However, because the ability of CGMs to carry out this intergenerational transmission of social skills is challenged, examining joint social intelligence training for CGM-ACG dyads is valuable for reversing this negative sequela. Yet, to date, no other investigators have done so. To address this gap, we will conduct an online randomized clinical trial with 340 nationally-recruited CGM-ACG (ages 12-18) dyads assigned to either the SII or an attention control condition. Data will be obtained at pre- and post-test, and at 3-, 6-, and 9-month follow-ups via questionnaires completed by phone. Daily dairies will be collected online from 170 randomly selected dyads, and qualitative interviews will be conducted with 60 dyads to probe how the SII affected their daily social competence and social ties. We will obtain quantitative and qualitative measures of key social cognitive processes, quality of close interpersonal ties, psychological well-being, and physical health. Administrative medical, criminal, and education records for all 340 dyads will also be obtained for cost-benefit analyses that examine changes in burden on public systems. These mixed-methods allow rigorous examination of four specific aims: (1) To investigate if the SII enhances social competencies that, in turn, produce long-term changes in relationship quality, well-being, and physical health; this includes determining if increased social competence in one dyad member leads to partner effects in the other; (2) To examine if cumulative risk, gender, and age moderate SII efficacy; (3) To study qualitatively how CGM-ACG dyads view the SII as having changed their social competencies and yielded positive outcomes; and (4) To assess the financial benefits of the SII to participants and their communities. These aims address a highly significant public health problem that will inform future efforts to support a wide range of high risk families, like custodial grandfamilies, who typically have insufficient access to formal support services. Our SII is advantageous because it is inexpensive, delivered online, non-stigmatizing, and capable of reaching a target population that is geographically disperse and greatly in need of supportive programming.