Project Healthy Grandparents (PHG)
About This Program
Target Population: Grandparent-headed families of grandchildren (ages birth to 16 years) in which the birth parents are absent
For children/adolescents ages: 0 – 16
For parents/caregivers of children ages: 0 – 16
Program Overview
The goal of PHG is to improve the well-being of families in which grandparents are raising their grandchildren in parent-absent homes. PHG provides case management by master's prepared social workers, as well as health services by registered nurses. PHG's comprehensive services include monthly home visitations by registered nurses and social workers, parenting education classes and support groups, legal service referrals, as well as early intervention services for young children. In many cases, referrals are made to other healthcare or community service providers, and transportation services are available, if needed. To be eligible for services, the grandparent(s) must be responsible for at least one grandchild age 16 years or younger and the child's parents must be absent from the home. Once enrolled, participants have access to all PHG services free of charge for one year. Participation in support groups is available after completion of the full year of comprehensive services.
Program Goals
The goals of Project Healthy Grandparents (PHG) are:
- Decrease psychological stress in grandparents
- Improve family resources
- Improve family social support
- Improve physical and mental health of grandparents
- Improve parenting skills
- Decrease child behavior problems
- Improve developmental outcomes for children birth through 5 years
Logic Model
View the Logic Model for Project Healthy Grandparents (PHG).
Essential Components
The essential components of Project Healthy Grandparents (PHG) include:
- Individual monthly home visitations by social workers. PHG's social workers provide:
- Parenting information
- Family support
- Consultations on public benefits, such as Temporary Assistance for Needy Families (TANF)
- Referrals to handle critical housing, food, and legal needs
- The breadth and depth of PHG's social work services provide grandparents with the information, referrals, and resources they need to establish a secure and safe environment for their grandchildren.
- Individual monthly or bimonthly home visitation by registered nurses (RNs):
- In-home healthcare support services for grandparents:
- Blood pressure monitoring
- Glucose (blood sugar) screening
- Cholesterol screening
- Mental health screening
- Vision screening
- Weight monitoring
- Nutrition counseling
- Many grandparents raising grandchildren have one or more significant chronic diseases (e.g., hypertension, obesity/overweight, diabetes).
- Helping clients learn to manage their chronic diseases effectively is essential if they are to continue as the primary care provider of their grandchildren.
- Monthly support groups:
- Goal: Providing peer support and education on various topics of concern to participants
- Typical attendance: 20-25 grandparents per session
- Individual or group parenting education/support:
- Social workers are trained in the Triple P parenting model
- Use Triple P to educate the grandparents on parenting strategies.
- Individual early intervention (EI) services:
- All children age birth to 5 years of age screened for possible developmental delays using the Ages and Stages Questionnaire (ASQ)
- All children who determined to be "suspect" in terms of the results of the ASQ or who have a history of alcohol or drug exposure in utero/during pregnancy are referred for a comprehensive developmental evaluation at the Neurodevelopmental Clinic at Emory University School of Medicine
- PHG's EI specialist:
- Works closely with the families on any EI service recommendations made by Emory University School of Medicine
- Assures that the children receive any necessary services
- Provides developmentally appropriate learning materials for the grandchildren to use
- Individual health screenings:
- All children receive health screenings by RNs
- Referrals made to primary care providers and specialists, as needed
- Health education provided to the children by RN
- Homework assistance:
- Available for school age children when they are experiencing educational challenges
- Typically provided by graduate students enrolled in education-related graduate degree programs
- Individual or group transportation services provided by PHG for grandparents so they can attend:
- Support group meetings
- Parenting classes
- EI appointments
- Select health care appointments
Program Delivery
Child/Adolescent Services
Project Healthy Grandparents (PHG) directly provides services to children/adolescents and addresses the following:
- Behavior problems, school/learning challenges, developmental challenges
Parent/Caregiver Services
Project Healthy Grandparents (PHG) directly provides services to parents/caregivers and addresses the following:
- Caregiver psychological distress, including depression
- Grandparent of a child with behavior problems
- Grandparent of child with developmental delay
- Grandparent with one or more chronic diseases that could impair ability to parent effectively
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Clients who participate in group support sessions are welcome to bring spouses or significant others. Health care screenings and services are available to all residents of the home. Grandparents work with their social workers to identify sources of social support (e.g. relatives, friends, church members, neighbors, etc.). Spouses of grandparent caregivers also receive social services as needed.
Recommended Intensity:
Separate 1- to 2-hour home visits with a social worker and an RN occur monthly. Monthly support groups last 2 hours.
Recommended Duration:
12 months; upon completion grandparents may continue to attend the monthly support group meetings and receive referrals for community resources.
Delivery Settings
This program is typically conducted in a(n):
- Adoptive Home
- Foster / Kinship Care
- Community-based Agency / Organization / Provider
Homework
Project Healthy Grandparents (PHG) includes a homework component:
School-age children are eligible to receive homework assistance on a weekly basis during the school year.
Resources Needed to Run Program
The typical resources for implementing the program are:
- Access to meeting rooms for support groups.
- Staff
- Computers
Manuals and Training
Prerequisite/Minimum Provider Qualifications
The minimum qualifications for social workers is a Bachelor's degree in social work, although a Master's degree in social work is preferred. For registered nurses, a Bachelor's of Science degree in nursing is required.
Manual Information
There is not a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- Susan Kelley, RN, PhD
skelley@gsu.edu
phone: (404) 413-1091
Training Type/Location:
Onsite training is a possibility, if travel expenses for the trainer are covered
Number of days/hours:
1.5-2 days at Georgia State University, or elsewhere
Relevant Published, Peer-Reviewed Research
Kelley, S. J., Yorker, B. C., Whitley, D. M., & Sipe, T. A. (2001). A multimodal intervention for grandparents raising grandchildren: Results of an exploratory study. Child Welfare, 80(1), 27-50.
Type of Study:
One-group pretest-posttest study
Number of Participants:
24
Population:
- Age — Children: Mean=6.8 years, Adults: 39-78 years (Mean=55.7 years)
- Race/Ethnicity — Children: Not specified, Adults: 100% African American
- Gender — Children: Not specified, Adults: 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This purpose of this study was to examine the efficacy of Project Healthy Grandparents (PHG) to improve reduce psychological stress, improve physical and mental health, and strengthen the social support and resources of grandparents raising grandchildren. Measures utilized include the Grandparent Interview Form, the Brief Symptom Inventory (BSI), the Family Resource Scale (FRS), the Family Support Scale (FSS), the Short Form 36 (SF-36) General Health Survey, and the Family Crisis Oriented Personal Evaluation Scales (F-COPES). Results indicated improved mental health scores, decreased psychological distress scores, and increased social support scores. Participants also experienced improvement in the level of public benefits received and in their legal relationships with their grandchildren. Limitations include lack of randomization, lack of control group, small sample size, lack of follow-up, and lack generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: None.
Kelley, S. J., Whitley, D., & Sipe, T. (2007). Results of an interdisciplinary intervention to improve the well-being and physical functioning of African American grandmothers raising grandchildren. Journal of Intergenerational Relations, 5(3), 45-64. doi:10.1300/J194v05n03_04
Type of Study:
One-group pretest-posttest study
Number of Participants:
120
Population:
- Age — 38-83 years (Mean=56.2 years)
- Race/Ethnicity — 100% African American
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This purpose of this study was to examine the efficacy of Project Healthy Grandparents (PHG) to improve the psychosocial well-being and physical functioning of grandmothers raising grandchildren. Measures utilized include the Grandparent Demographic Form, the Brief Symptom Inventory (BSI), the Family Resource Scale (FRS), the Family Support Scale (FSS), the Short Form 36 (SF-36) General Health Survey and the Family Crisis Oriented Personal Evaluation Scales (F-COPES). 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. Limitations include lack of randomization, lack of control group, lack of follow-up, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: None.
Kelley, S. J., Whitley, D. M., & Campos, P. E. (2010). Grandmothers raising grandchildren: Results of an intervention to improve health outcomes. Journal of Nursing Scholarship, 42, 379-386. doi:10.1111/j.1547-5069.2010.01371.x
Type of Study:
One-group pretest-posttest study
Number of Participants:
529
Population:
- Age — 38-83 years (Mean=56.7 years)
- Race/Ethnicity — 98.5% African American and 1.5% White or Hispanic
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This article explored the impact of Project Healthy Grandparents (PHG) to improve the health of grandmothers raising grandchildren in parent-absent homes. Measures utilized include the Short Form-36 General Health Survey (SF-36). Results indicated that comparison of pretest and posttest mean scores on the SF-36 indicated significantly 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. Limitations include lack of randomization, lack of control group, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: 12 months.
Whitley, D. M., Kelley, S. J., & Campos, P. E. (2011). Perceptions of family empowerment among African American custodial grandmothers raising grandchildren: Thoughts for research and practice. Families in Society: Journal of Contemporary Social Services, 383-389. doi:10.1606/1044-3894.4148
Type of Study:
One-group pretest-posttest study
Number of Participants:
311
Population:
- Age — 36-83 years (Mean=56.8 years)
- Race/Ethnicity — 98.5% African American and 1.5% Other
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This article explored the impact of Project Healthy Grandparents (PHG) in regards to empowerment practice on grandmothers raising grandchildren. Measures utilized include the Family Empowerment Scale (FES), the Family Support Scale (FSS), and the Short Form-36 General Health Survey (SF-36). Results indicated that the service model appears to have enhanced perceptions of empowerment with the sample of African American grandmothers. Additionally, the service intervention supports the empowerment dimensions and three subscales (knowledge, advocacy, and self-efficacy); the results did not support the competency subscale. Although all age groups experienced an increase in empowerment, older grandmothers had significant differences in perceptions regarding social systems, as well as a sense of competency as compared with younger grandmothers. Limitations include lack of randomization, lack of control group, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: None.
Kelley, S. J., Whitley, D. M. & Campos, P. E. (2013). African American caregiving grandmothers: Results of an intervention to improve health indicators and health promotion behaviors. Journal of Family Nursing, 19(1), 53-73. doi:10.1177/1074840712462135
Type of Study:
One-group pretest-posttest study
Number of Participants:
504
Population:
- Age — 38-83 years (Mean=56.7 years)
- Race/Ethnicity — 100% African American
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This purpose of this study was to examine the efficacy of Project Healthy Grandparents (PHG) to improve the health of grandmothers raising grandchildren. Measures utilized include the Healthier People Health Risk Appraisal (HRA). Results indicated that a comparison of pretest and posttest scores indicated significant 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. Limitations include lack of randomization, lack of control group, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: 12 months.
Whitley, D. M., Lamis, D. & Kelley, S. J. (2016). Mental health stress, family resources and psychological distress: A longitudinal mediation analysis in African American Grandmothers Raising Grandchildren. Journal of Clinical Psychology, 72, 563–579. doi:10.1002/jclp.22272
Type of Study:
One-group pretest-posttest study
Number of Participants:
679
Population:
- Age — Adults: 33-83 years (Mean=55.76 years)
- Race/Ethnicity — Adults: 98.5% African American
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This study examines the effectiveness of Project Healthy Grandparents (PHG) for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. Measures utilized include the Short Form-36 General Health Survey (SF-36), the Family Resource Scale (FRS), and the Brief Symptom Inventory (BSI). Results indicated that perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between grandmothers experiencing low levels of mental health and those experiencing high levels of mental health stress. Limitations include lack of randomization, lack of control group, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: 12 months.
Whitley, D. M., Kelley, S. J., & Lamis, D. A. (2016). Depression, social support, and mental health: A longitudinal mediation analysis in African American custodial grandmothers. The International Journal of Aging and Human Development, 82(2-3), 166-187. doi:10.1177/0091415015626550
Type of Study:
Two-group pretest-posttest study without control group
Number of Participants:
667
Population:
- Age — Adults: 33-83 years (Mean=55.90 years)
- Race/Ethnicity — Adults: 98.5% African American, 1.5% Other
- Gender — 100% Female
- Status — Participants were recruited via community agencies serving children and families.
Location/Institution: Southeastern United States
Summary:
(To include basic study design, measures, results, and notable limitations)
This article explored the impact of Project Healthy Grandparents (PHG) in regards to the relationship between depression and mental health quality of life mediated by social support, among younger (55 or younger) versus older (55+) African American grandmothers raising grandchildren. Measures utilized include the Brief Symptom Inventory (BSI), the Family Support Scale (FSS), and the Short Form-36 General Health Survey (SF-36). Results indicated that 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. Additionally, there was a positive correlation between perceived helpfulness of support sources and mental health quality of life at 12-month follow-up in younger and older grandmother parenting groups. Results also indicate younger grandmothers experienced higher levels of depressive symptoms at baseline and lower levels of mental health quality of life when compared with older grandmother. Limitations include lack of randomization, lack of control group, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: 12 months.
Kelley , S. J., Whitley, D. M., & Campos, P. E. (2019). Differential impact of an intervention for grandmothers raising grandchildren. Journal of Intergenerational Relationships, 17(2), 141-162. doi:10.1080/15350770.2018.1535351
Type of Study:
One-group pretest-posttest
Number of Participants:
549
Population:
- Age — Adults: 33-83 years (Mean=56.27 years)
- Race/Ethnicity — Adults: 100% African American
- Gender — 100% Female
- Status — Participants were predominantly low income grandmothers raising grandchildren.
Location/Institution: Not specified
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of this present study was to determine the efficacy of Project Healthy Grandparents (PHG) to decrease psychological distress in caregiving grandmothers, as well as to determine if select demographic characteristics influence intervention outcome. Measures utilized include the Brief Symptom Inventory (BSI). Results indicated that psychological distress scores decreased significantly from pretest to posttest. The intervention appears to have benefited distressed grandmothers who are young, unmarried, or unemployed. Limitations include lack of control group, attrition, reliance on self-reported measures, and lack of generalizability due to ethnic composition of the participants.
Length of controlled postintervention follow-up: 12 months.
Additional References
Chan, K. L., Chen, M., Lo, K. M. C., Chen, Q., Kelley, S. J., & Ip, P. (2019). The effectiveness of interventions for grandparents raising grandchildren: A meta-analysis. Research on Social Work Practice, 29(6), 607-617. doi:10.1177/1049731518798470
McLaughlin, B., Ryder, D., & Taylor, M. F. (2017). Effectiveness of interventions for grandparent caregivers: A systematic review. Marriage & Family Review, 53(6), 509-531. doi:10.1080/01494929.2016.1177631
Sumo, J. N., Wilbur, J., Julion, W., Buchholz, S., & Schoeny, M. (2018). Interventions to improve grandparent caregivers' mental and physical health: An integrative review. Western Journal of Nursing Research, 40(8), 1236-1264. doi:10.1177/0193945917705376
Contact Information
- Susan Kelley, RN, PhD
- Agency/Affiliation: Georgia State University
- Website: phg.lewis.gsu.edu
- Email: skelley@gsu.edu
- Phone: (404) 413-1091
Date Research Evidence Last Reviewed by CEBC: February 2017
Date Program Content Last Reviewed by Program Staff: September 2019
Date Program Originally Loaded onto CEBC: March 2017
