Location, individual circumstances impact caregiver well-being, researchers find
Caregivers have higher well-being in urban areas, where more support is available, than those in suburban or rural areas, according to a new study
Penn State
UNIVERSITY PARK, Pa. — Roughly a quarter of adults in the U.S. are caring for elderly family members or children with an illness or disability — and sometimes both at the same time. Despite family caregiving consuming time and resources for both individuals and governments, social scientists don’t fully understand how it affects the people who do the caregiving, according to a team led by researchers at Penn State. In collaboration with colleagues at Purdue University and the University of Minnesota, the researchers conducted an expansive study of caregiver well-being, finding that the type of geographic location and individual circumstances can impact a caregiver’s health, comfort and happiness even more than their state’s family care policies.
In findings recently published in Rural Sociology, the researchers reported that rural and suburban caregivers were more likely to have low or medium well-being, and less likely to have high well-being compared to urban caregivers. And caregivers’ personal characteristics — such as age, income and education — had a stronger effect on their well-being than the family care policies of the state they live in. However, the researchers concluded, family-care policies can make a difference in well-being when they take into account the differences among rural, suburban and urban areas — especially in terms of available support and infrastructure.
“Although caregiving can be an emotionally rewarding and satisfying experience, caregivers often face significant stress and challenges in their roles, and the impacts of caregiving on well-being are often overlooked by researchers and policymakers,” said Elena Maria Pojman, first author on the paper and a doctoral degree candidate in sociology and demography in the Department of Sociology and Criminology at Penn State.
To understand caregiver well-being more clearly, including how it differs among rural, suburban and urban caregivers, the researchers used two publicly available datasets. One was the caregiving survey from the North Central Regional Development Center and is a collaboration with the Northeast Regional Center for Rural Development, which is based at Penn State. This survey includes survey responses from 4,620 caregivers about their lived realities looking after either children or adults in the North Central and Northeast regions of the United States. The other dataset was from a group of researchers at the University of North Carolina at Chapel Hill, and it includes information about state-level programs and policies connected to the availability of services such as respite care, daycare, special transportation and state-paid leave from their jobs for caregiving.
By merging these two datasets for the current study, the researchers assessed how caregivers are doing and whether state-level policies — laws and programs related to family care — play a role in caregiver well-being. First, the team’s analysis revealed that caregivers could be grouped by well-being ratings of high, medium or low, based on how they responded to several facets of their well-being: happiness, self-rated health and how caregiving has affected their physical health, mental/emotional health and social life. Then, the researchers used a statistical technique that predicts probability of an outcome with more than two categories to analyze how likely people from rural, suburban or urban areas were to fall into each category.
The researchers concluded rural and suburban caregivers were more likely to have lower well-being than urban caregivers, but the overall differences among the three were small. However, Pojman pointed out, the analysis indicated that suburban caregivers were more like rural caregivers than urban ones — which contradicts previous research by other scientists that grouped suburban and urban caregivers together.
“Suburban caregivers often face unique challenges stemming from their geographical and social position, which differ from the issues experienced in urban or rural environments,” Pojman said, explaining that the study highlighted the need for better-targeted policies and resources. “Balancing caregiving with work, parenting and personal needs is often compounded by suburban-specific factors such as limited public transit and the isolation that comes from living in more spread-out communities.”
The researchers also concluded that support systems are crucial — caregivers who had access to paid help and community support specific to caregiving tended to have higher well-being. Less specific support, like broad federal programs, was more weakly linked to high well-being. This suggests that policy should focus on making caregiving-specific supports more accessible, explained team leader and senior author, Florence Becot, Nationwide Insurance Early Career Professor of Agricultural Safety and Health Program Lead in Penn State’s College of Agricultural Sciences
“Although caregiving can be an emotionally rewarding and satisfying experience, caregivers often face significant stress and challenges in their roles, and the impacts of caregiving on well-being are often overlooked by researchers and policymakers,” she said. “Caregivers often report a complex range of feelings regarding the care they provide and its impact on their life, ranging from immense financial and emotional burdens, to joy and personal growth. There’s a clear need for better family-care policies that reflect the real differences in support needs across rural, suburban and urban areas — especially to help those caregivers who are struggling.”
Because caregiving experiences vary so much, it’s important to consider caregiver well-being in a nuanced and individualized way, Becot added.
“Understanding the challenges caregivers face in different social, demographic and geographic contexts and circumstances helps researchers, health care providers and policymakers better support caregivers — especially those at risk of burnout or emotional distress,” she said.
Zuzana Bednarik, North Central Regional Center for Rural Development, Purdue University, and Carrie Henning-Smith, School of Public Health, University of Minnesota, contributed to the research.
Funding for this research was provided by The Nationwide Insurance Endowment in Penn State’s College of Agricultural Sciences; the North Central Centers for Rural Development; the Northeast Regional Centers for Rural Development; the U.S. Department of Agriculture’s National Institute of Food and Agriculture; North Central Regional Association of State Agricultural Experiment Station Directors; and North Central Cooperatives of Extension Association.
Journal
Rural Sociology
Method of Research
Survey
Subject of Research
People
Article Title
Does Caregiver Well-Being Differ by Rurality and State Policy Environment? Identifying a Well-Being Typology for Rural, Suburban, and Urban Caregivers
KU program found effective in helping reduce stress among child welfare service providers
Secondary traumatic stress decreased, resilience increased for child care workers in less time, study finds
University of Kansas
LAWRENCE — Child welfare professionals work in a stressful environment. Seeing families at risk of having children removed from the home frequently results in occupational trauma, burnout and negative health outcomes. University of Kansas researchers have published a study showing an intervention they delivered to child welfare workers across the state reduced secondary traumatic stress and improved resilience, which can ease the strain on workers and lead to better family outcomes.
Researchers from KU’s School of Social Welfare implemented an intervention known as Resilience Alliance to child welfare caseworkers from across the state. The intervention was delivered across 12 weeks to help these professionals recognize secondary traumatic stress, or STS, develop strategies to deal with its effects and build resilience skills to use in their everyday work.
Results showed the intervention lowered secondary traumatic stress and boosted resilience while being delivered remotely and in a shorter time than previous versions. The study was also distinct from other studies because participants were grouped in like positions, such as pairing caseworkers with other caseworkers.
“Child welfare workers are at high risk of experiencing STS. These are folks who go into homes and deal with children being removed or at risk of being removed or experiencing abuse,” said Brennan Miller, research associate in KU’s School of Social Welfare and one of the study authors. “Workers see lots of cases with positive outcomes, but they are bound to experience trauma in their work.”
When observing another person’s trauma and working to help, child welfare professionals can experience STS, which research has recognized as a significant challenge that leads to burnout and higher turnover rates. However, little research has identified evidence on strategies to address the issue. KU researchers received a six-year, $8 million grant from the U.S. Department of Health and Human Services, Administration for Children and Families, to implement and evaluate strategies that could improve child welfare agency practices, including those that help reduce STS.
The intervention was delivered remotely to a sample of 175 Kansas child welfare workers. Half of the sample received the intervention, and half received the intervention plus loving-kindness meditation. Results showed a statistically significant reduction in STS for all participants. However, the results did not show receiving the additional loving-kindness meditation treatment provided additional reduction in STS above and beyond the standard Resilience Alliance programming.
Participants were surveyed before and after the 12-week intervention to assess levels of STS and resilience. Researchers hypothesized participants would demonstrate improved psychological well-being and reductions in STS following the intervention, and results confirmed that.
STS can present negative physical and mental outcomes for those who experience it, similar to post-traumatic stress disorder. Participants were asked about how well they sleep, if they experience symptoms like stress or anxiety and a number of other questions about their experiences before and after the intervention.
Resilience Alliance is designed to help participants develop awareness of stress and negative emotions that may be common in child welfare practice. It focuses on developing agency and skills for participants to reposition negative emotions into positive emotions and take steps to channel their emotions into action that both benefits their well-being and the clients they serve.
“One thing I think is cool about this study is people often view resilience as a trait. Either you are resilient or you aren’t,” Miller said. “But we viewed it as, ‘Can you employ this as a skill?’ And our results suggest you can.”
The study, written by Shelby Clark of the University of Kentucky, who received her doctorate at KU; Miller, co-principal investigator; Becci Akin, KU professor of social welfare and principal investigator; Kortney Carr, KU assistant professor of social welfare; Vickie McArthur, program manager at KU’s School of Social Welfare; and Ryan Barney of the University of Kentucky, was published in the journal Traumatology.
Resilience Alliance showing the ability to reduce STS and boost resilience has several benefits, the authors wrote. It reduces stress among child welfare providers, which can help reduce burnout and turnover among a workforce that routinely experiences both at high rates. Additionally, it can lead to better psychological and health outcomes for professionals, who can in turn provide better services to clients, which has the potential to improve outcomes for families.
Future research should continue to examine the effects of Resilience Alliance on STS and resilience as well as its potential benefits for supervisors and administrators, the authors wrote, but in the meantime current results show that not only is the intervention promising for reducing STS, but it was adapted from a 24-week intervention into a 12-week course that also proved to be effective when delivered remotely. That reduces financial and time obligations for agencies and states looking to provide the intervention to their child welfare providers.
With those positive outcomes, KU researchers developed a sustainability plan as part of the original grant to help agencies continue to provide Resilience Alliance training to child welfare workers across Kansas by the Children’s Alliance of Kansas. Additionally, the Kansas Legislature provided continued funding for the program to help reduce STS and improve family outcomes across the state.
Journal
Traumatology An International Journal
Method of Research
Observational study
Subject of Research
People
Article Title
Investigating the effects of resilience and meditation interventions on secondary traumatic stress among child welfare professionals: A randomized clinical trial
