Use of Community and School Mental Health Services by Custodial Grandchildren

We examined patterns and predictors of perceived need, use, and unmet need for mental health services by custodial grandchildren within the school-based and community-based delivery sectors. Data were from a national sample of 610 grandmothers caring for grandchildren ages 6 to 17 in the absence of biological parents. Overlapping use of services across both sectors was common, although use of school-based services (51%) was higher than that of community-based services (37%). Multiple regression analyses based on the Andersen Behavioral Model revealed the following shared predictors of mental health service use across both sectors: grandchildren's externalizing symptoms, other grandchildren in the household with medical or psychiatric diagnoses, and corresponding use of services in the other sector. Predictors were similar when analyses were conducted with families recruited by either probability or convenience-based methods. Findings suggest the need to coordinate and integrate mental health services for custodial grandchildren across different delivery sectors.Key Words: custodial grandparents, family caregiving. grandchild mental health, service use.The number of grandparents providing care to grandchildren has increased substantially over the past two decades. According to the U.S. Census Bureau (2003), approximately 6 million grandparents lived with their grandchildren in 2000, and about 2.4 million of these grandparents had primary responsibility for their coresident underage grandchildren (Simmons & Dye, 2003). Furthermore from 2000 to 2008 the number of custodial or "skipped generation" grandparents providing full-time care to grandchildren in the total absence of the child's biological parents increased by 8%, in particular during 2007 to 2008 in the initial years of the economic recession (Livingston & Parker, 2010). In comparison to those caregiving grandparents who reside with a grandchild's birth parents, custodial grandparents generally experience more strain and family vulnerability because they face heavier child-care responsibilities, less social support, and more adverse lifestyle changes (Jooste, Hayslip, & Smith, 2008).The importance of the present study was clearly suggested over a decade ago in an article published in this journal by Landry-Meyer (1999). Within a sample of270 randomly selected grandparents raising grandchildren in Ohio, she found that 83.4% were concerned about their grandchild's emotional health, more than 70% were concerned with behavioral issues and problems, and over two thirds ranked counseling services for grandchildren as important, with almost an equal number ranking information about the availability of services as important. We have been unable, however, to identify any published studies on factors associated with the use of mental health services by custodial grandchildren.Although numerous studies exist on the overall quality of life experienced by custodial grandparents (see, for reviews, Grinstead, Leder, Jensen, & Bond, 2003; Hayslip & Kaminski, 2005), much less attention has been devoted to the mental health status and school-related functioning of their grandchildren. Yet, factors such as poverty, stress, and limited access to medical and mental health services among custodial grandfamilies may contribute to their grandchildren's emotional, behavioral, and medical problems. In particular, the psychological distress and chronic illnesses common among custodial grandparents, combined with such stressors as inadequate support, social stigma, isolation, disrupted leisure or retirement plans, age-related adversities, anger toward grandchildren's parents, and financial strain (Whitley, Kelley, & Sipe, 2001), can disrupt their parenting behavior, which then impacts their grandchildren's adjustment adversely (Smith & Hancock, 2010; Smith, Palmieri, Hancock, & Richardson, 2008).Clinicians report that custodial grandchildren often have intense adjustment problems at home, as evidenced by attempts to defy authority and strain limit setting while pushing their grandparents, perhaps in part because of being abandoned by other caregivers (Brown-Stradridge & Floyd, 2000). …