Kinship Care: More Than Stand-ins

This article is reprinted with permission from The Kinship Toolbox, EMK Press

She spoke to me about how hard it had been, assuming the care of 5- and 7-year-old boys, her grandsons. The constant hum of the washing machine and the frequent trips to the grocery store were things that she had to reorient herself to after living alone for so many years. At 58 years of age, she had planned to work a few more years and then retire. But her son’s death and her daughter-in-law’s troubles with drug addiction and then, the law, had changed that plan when the boys came to live with her. She was lucky, she told me, because she was self-employed and could meet the additional expenses the boys created. Still, it was hard. She missed her son and she could barely keep up with the boys’ therapy appointments, the parent-teacher conferences, and the disruptions the boys’ mother caused after visiting. There was no permanent legal arrangement, but as a foster parent, she had visits from the social workers often enough. She was sad and depressed she said, so her doctor had pre- scribed an anti-depressant for her. The good news was that the boys were stabilizing. They needed her to be the parent, the mother.

Kinship parents — grandmothers, grandfathers, cousins, aunts, uncles, siblings, and close friends — who assume the primary care for children become more than stand-ins for those who gave birth to these children: you become parents. And as with many parents, kinship parents may struggle with depression. You may become immersed in a mist of loss that can threaten to engulf you at times.

Here are some common losses experienced by kinship parents:

Loss of a (functioning/independent) birth parent: Either through death, incarceration, or disappearance, the relative or friend who gave birth to the child is no longer in the environment. Or if the parent is in the environment, he or she is incapable of parenting the child.
Loss of a “healthy” grandchild/child: The child you are caring for may have multiple, complex needs, including medical, developmental, emotional, and educational. At times, these needs may overwhelm you and thrust you into a world of special needs children that seems foreign and complicated.
Loss of developmental role: An additional loss may be the mismatch between your chronological age and developmental role. Perhaps you may have assumed that you would enjoy freedom from the confines and responsibilities of being a parent, and be able to concentrate on moving forward to a new stage in your life that had included personal freedom.
Loss of control over your life: Tied to this mismatch may be a sense of loss of control over your life: suddenly, you are tethered to a child who depends on you for emotional and physical well-being. Finances may be a constant source of stress.
Loss related to the trauma or neglect the child may have experienced and a sense of guilt over those experiences. Had there been a way to prevent all this from happening? You may ask yourself whether you could have been a better par- ent the first time around.
Loss of a partnered relationship: Perhaps your spouse is the primary kinship parent. The relationship has changed and you may feel that what was once a second chance at a part- nered relationship has been diminished because of the energy your partner expends toward the children.
Loss related to aging, which may be amplified due to your new role of caregiver: You were already aware of the effects of aging on your body. You may even have been diagnosed with an illness. The additional physical and emotional energy to parent has taxed you to the point where you feel chroni- cally exhausted or ill.
Loss of being current: It is a new generation, filled with an affinity toward technology, trends and the use of gadgets that you simply cannot keep up with. You try to understand and control the environment, but it often becomes too much for you.
Loss of a predictable future and feeling secure: You are not sure, now, what the future will bring to your family. Should you pursue legal adoption of the child(ren)? What about retirement? Should you move to a larger home to accommo- date everyone? In exchange for predictability, you now have abundant change.

Signs and Symptoms of Depression

Depression can sometimes grow insidiously. You may have found yourself sleeping more/less, eating more/less, feeling anxious, and helpless during the past several weeks or months.

Strategies:

While there is often no one treatment plan for individuals who experience depression, there are common strategies that might help:

Get a physical evaluation. Know if there are physical problems that can be effectively treated and also rule out illnesses that can mimic depressive symptoms or make those symptoms worse. Your primary care provider can also refer you to a mental health professional if symptoms of depression are reported.
Try to build a support network. From your own personal environment to the larger environment, many Internet resources have been created that are credible and helpful. You are far from being alone: approximately 2.7 million people care for children of close friends and relatives.2
Know and use your tangible resources. Government agencies, AARP and other organizations now offer information on available resources, common challenges, and state listings of available assistance. Cities are now recognizing housing as a common problem for grandparents raising grandchildren and are beginning to respond to this need.
Educate yourself on your child’s needs. A child’s behaviors can frustrate and exhaust you; however, understanding the causes, symptoms, and best ways to respond to them will help both of you. The world of special needs children can be better understood by reading about their unique needs. Most libraries have solid collec- tions of books that can promote empathy and appreciation of the child’s world.
Let yourself grieve. Most mental health professionals see grieving as a normal part of life. The losses listed can evoke grief, anger, sadness and regret. Acknowledging loss and allowing oneself to grieve-and forgive-can be healing.

The Effects of Parental Depression

While it may be difficult to seek help, research findings describe potential negative out- comes to children who are in homes with parents who experience depression. Children’s intelligence scores have even been affected by mothers who experience depressive symptoms.3 The children under your care have already been through many transitions and even traumas. They are sensitive to the environment, which includes their parents, and need caregivers who are able to engage and interact. It is not easy to admit that you may be depressed. Despite how society has accepted struggles with mental illnesses, the stigma of reaching out for help can be a real and difficult barrier. So, know this: when you hesitate to obtain the help you need, be selfless once again and do it for the sake of your family and those who you care about. By helping yourself, you will help them.

Karen J. Foli, MSN, PhD, RN, is an associate professor at the Purdue University School of Nursing in West Lafayette, Indiana. She is the co-author of The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption (Rodale, 2004) and conducts research that examines nursing care of the adoption triad and depression in adoptive and kinship par- ents. Foli has been interviewed by journalists from The Washington Post, The New York Times, The Philadelphia Inquirer, and O! The Oprah Magazine for articles discussing post adoption depression.

1 Kroenke, K., Spitzer, R.L., Williams, J.B. (2003). The Patient Health Questionaire-2: Validity of a two-item depression screener. Medical Care, 41, 1284-1294.

2 The Annie E. Casey Foundation (2012). Stepping up for kids: What government and communities should do to support kinship families. Retrieved from: http://www.aecf.org/KnowledgeCenter/Publications.aspx?pubguid= {642BF3F2-9A85-4C6B-83C8-A30F5D928E4D}

3Hay, D.F., Pawlby, Sharp, Asten, Mills, & Kumar (2001). Intellectual problems shown by 11-year-old children whose moth- ers had postnatal depression. Journal of Child Psychology and Psychiatry, 42(7), 871-889.